Management of hypopituitarism during pregnancy in patients with PROP1-related combined pituitary hormone deficiency: Review of the literature with a case report

Abstract

Background: The management of pregnancy in patients with combined pituitary hormone deficiency (CPHD) represents a unique challenge due to the complex interplay of multiple pituitary hormone deficiencies, higher risk of feto-maternal complications, and lack of established evidence-based clinical guidelines. Though improvements in assisted reproductive techniques (ART) and multidisciplinary care over the last decades have increasingly enabled successful pregnancies in hypopituitary women, genetic causes of CPHD are rarely identified and data on pregnancy outcomes in affected women are scarce, underscoring the need for further case documentation to better inform clinical practice.

Aims: We describe the case of a woman with genetically confirmed PROP1-related CPHD who achieved and completed a successful pregnancy through ART and tailored endocrine management throughout gestation and the postpartum period. This case report highlights the importance of preconception counseling, careful hormone replacement, and close monitoring and collaboration among expert endocrinologists, obstetricians, and neonatologists to optimize maternal and fetal outcomes in women with genetic CPHD. Furthermore, we provide a comprehensive literature review exploring key issues related to the main clinical and therapeutic challenges in the management of hypopituitarism during pregnancy, and particularly in the context of CPHD.

Keywords: Combined pituitary hormone deficiency; Hormone replacement therapy; Hypopituitarism; Pregnancy.

Fig. 1

Trend of main clinical and biochemical parameters monitored during pregnancy. The panels represent: a) free thyroid hormones (fT3, fT4); b) maternal weight; c) systolic blood pressure; d) sodium levels; e) potassium levels; f) blood glucose. Abbreviations: LT4, levothyroxine; HC, hydrocortisone; Na, sodium; K, potassium; SBP, systolic blood pressure. Arrows mark the time when hydrocortisone dose escalation began. fT3 normal range: 2-4.4 pg/mL, fT4 normal range 9.2-16.8 pg/mL

Fig. 2

Overview of clinical and biochemical assessment, and therapeutic adjustments made in preparation for assisted reproduction, during the trimesters of pregnancy and in the postpartum period. Created with Biorender.com. Abbreviations: LT4, levothyroxine; HC, hydrocortisone; MRHC, modified-release hydrocortisone; rhGH, recombinant human growth hormone; ART, assisted reproductive techniques; wks, weeks; Na, sodium; K, potassium; GDM, gestational diabetes mellitum; C-section, Caesarian section; PRL, prolactin