Successful pregnancy in a patient with central hypothyroidism following tran-sphenoidal surgery for an adrenocorticotropic hormone-secreting pituitary adenoma

ABSTRACT

A case of a 26 year-old primigravid with central hypothyroidism resulting from transphenoidal excision surgery (TSE) for an adrenocortic-producing pituitary macroadenoma is presented. Free thyroxine level was low 8 months post TSE and patient was started on levothyroxine therapy. Fortunately, she became pregnant 18 months after levothyroxine medication was started. Repeat cranial Magnetic Resonance Imaging (MRI) did not show any evidence of tumor recurrence. She was also diagnosed with diabetes mellitus type 2 and hypertension and was maintained on premixed insulin and methyldopa. Patient's prenatal course was uneventful with essentially normal antenatal surveillance tests and normal thyroid function tests. Patient was admitted on her 38 1/7 weeks age of gestation for labor induction because of a non-reactive stress test. She delivered a live baby girl, weighing 2600 grams, 37 weeks by pediatric aging with an APGAR score of 9 becoming 9, via assisted vaginal delivery under epidural anesthesia. Postpartum courses were both unremarkable.