E-Poster Presentation ESA-SRB-ANZBMS 2021

We report the case of a 32 year-old woman, G1P1, with lymphocytic hypophysitis and hypopituitarism diagnosed 6 months post-partum. She was admitted to the Mother and Baby Unit 6 months post-partum with anhedonia, low mood, fatigue and difficulty with attachment and bonding with her baby. During the pregnancy at 30 weeks gestation, she had been admitted with a severe headache, the cause of which was not identified at the time. At the post-partum admission, thyroid function tests done as part of a routine depression screen were suggestive of secondary hypothyroidism.  Other pituitary hormones followed showing multiple deficiencies (see below).  Pituitary MRI was unremarkable at this time.

She commenced glucocorticoid and thyroid hormone replacement and started the oral contraceptive pill. At subsequent follow up, a glucagon stimulation test was arranged. Growth hormone deficiency was confirmed and she commenced daily growth hormone injections. At approximately 14 months post-partum, she decided to cease the oral contraceptive pill and fell pregnant shortly thereafter. At 11 weeks gestation in the second pregnancy, she developed gestational thyrotoxicosis when she presented with hyperemesis gravidarum. Managing the concurrent diagnoses of HCG mediated thyrotoxicosis and underlying secondary hypothyroidism proved challenging with hypothyroidism occurring with thyroxine dose reduction. 

Lymphocytic hypophysitis is an inflammatory disorder of the pituitary which occurs most often in the third trimester of pregnancy or within 1 year post-partum [1]. It can present with headache, visual disturbance or symptoms of pituitary insufficiency. Though rare, it should be considered in the differential diagnosis of headaches in pregnancy and post-partum [2].