Detailed hormonal studies during and after pregnancy in a previously hypophysectomized patient.

Abstract

ABSTRACT This is a report on detailed hormonal studies before, during, and after pregnancy in a hypophysectomized patient who conceived after treatment with human gonadotrophins. On the basis of the results the following conclusions were drawn: In a patient who, judging by numerous investigations, no longer had any production of pituitary gonadotrophic hormones, it was possible by treatment with human gonadotrophic hormones to induce ovulation, without further stimulation to attain conception and preserve the conceptus, to carry through a normal pregnancy, ending at term in vaginal delivery of a normal infant. In this patient, whose pituitary corticotrophin production had totally ceased or had been negligible before the pregnancy, the endocrine state appeared to be completely normalized during pregnancy; thus: on unchanged corticosteroid medication the mean plasma corticoid concentration as well as the urinary excretion of corticoid metabolites, 17-ketogenic steroids, and 17-ketosteroids were considerably higher during than after the pregnancy, the urinary excretion of pregnanediol, oestriol and chorionic gonadotrophin was normal during the pregnancy. Moreover, the results of metyrapone tests before, during and after the pregnancy, ACTH stimulation test after delivery, and measurements of diurnal fluctuations in the concentration of plasma cortisol during the pregnancy are reported. The increased steroid production during pregnancy may be partially explained as a consequence of the activity in the foeto-placental unit which, however, can hardly have been quantitatively decisive. It must be presumed, therefore, that as a result of the pregnancy ACTH or an ACTH-like factor has been secreted, stimulating the maternal adrenal. It is assumed that the corticotrophin has been produced in the placenta and that it has passed to the maternal circulation.