Iatrogenic panhypopituitarism: how many puzzles you need to solve on your way to pregnancy: a clinical case

Abstract

Introduction. Iatrogenic panhypopituitarism requires specific approaches to infertility treatment, prenatal care and childbearing. Aim: to show difficulties and peculiarities of infertility treatment of a patient with iatrogenic panhypopituitarism. Methods and materials. We present a clinical case of an infertile patient with panhypopituitarism followed the operation for a chromophobe pituitary adenoma. Results. The 31-year old infertile patient was operated at the age of 21 for pituitary adenoma, the surgery was followed by the hormone replacement therapy. At examination: Anti-Mullerian hormone - 0,28 ng/mL., uterine hypoplasia by ultrasound, hysterosalpingography showed that fallopian tubes were passable, normospermia. Three ovulation stimulations were performed: the first one - Menopur®, the step up protocol (after 44-day period one dominant follicle developed); the second - Menopur® step up (after 26-day period 4 follicles developed), both times - biochemical pregnancy; the third stimulation - 20 days using Gonal-F® 150 ME and Pregnyl 70 M.E., 4 follicles developed, childbirth went after pregnancy. During the stimulation, growth hormone, cortisol and low molecular weight heparin were added, with the extension of the growth hormone administration to the 36th week of gestation. Conclusion. Patients with hypogonadotropic hypogonadism are a population in which ovulation stimulation leads to folliculogenesis in 80 % of cases. The following questions remain debatable: Is the corresponding function achieved when solving the problem of uterine hypoplasia? Should we add growth hormone and for how long? How to evaluate the follicular reserve, and is Anti-Mullerian hormone accurate in such patients? What is the best compensation for luteinizing hormone activity? Is human chorionic gonadotropin the key to pregnancy?