Growth Hormone Therapy Restores Fertility in a Woman With Isolated Growth Hormone Deficiency From Chronic Sheehan Syndrome

Abstract

Sheehan syndrome is a rare condition of pituitary necrosis following postpartum hemorrhage, hypovolemia, and/or associated shock, presenting with lactation failure and acute hypopituitarism immediately postpartum; chronic hypopituitarism can manifest months to years later. We present a patient with chronic Sheehan syndrome with isolated growth hormone (GH) deficiency presenting with secondary infertility in whom GH replacement led to natural conception, demonstrating reversibility of infertility. A 38-year-old female patient was referred for secondary infertility on a background of postpartum hemorrhage and inability to breastfeed postpartum 4 years earlier. During workup for secondary infertility, her investigations revealed an isolated GH deficiency, confirmed on a glucagon stimulation test, and a partially empty sella and a thin, 1.6-mm pituitary gland on magnetic resonance imaging, supportive of chronic Sheehan syndrome. Other fertility investigations were unremarkable. Before GH replacement, the patient had 1 unsuccessful cycle of in vitro fertilization. After 2.5 months of GH replacement, the patient achieved natural conception. Individuals with a history of postpartum hemorrhage, agalactorrhea, and symptoms potentially indicative of hypopituitarism should be investigated for chronic Sheehan syndrome. In pituitary pathology, GH deficiency should be considered as a potential contributor to infertility, which can be treated and potentially reversed with GH replacement.

Keywords: Sheehan syndrome; growth hormone deficiency; hypopituitarism; infertility.

Figure 1.

T1-weighted coronal post-contrast MRI pituitary demonstrating a partially empty sella with a thin, 1.6-mm pituitary gland, suggestive of chronic Sheehan syndrome.