Category: Pituitary Disorders/Neuroendocrinology
Objective : To present a case of autoimmune hypophysitis (AIH) after childbirth.
Methods : The clinical and paraclinical characteristics of the patient are described
Results : Woman, 27 yo; father with T2DM. During her pregnancy, she was diagnosed with gestational diabetes and in january 2018 she underwent cesarean at 32 weeks of pregnancy due to PRM. At 4 months postpartum, he has a moderate-intensity, constant headache associated with polydipsia, polyuria (10 liters/d) and nocturia. In his district she was admitted to the emergency department due to moderate dehydration, received IV hydration and carbamazepine 200mg bid with slight improvement. In June 2018, she was referred to our hospital. At admission she presented: HR 78x, Weight: 68 kg, PA: 120/80, BMI: 29, acanthosis nigricans in the armpits, dry mucosa, during hospitalization, polyuria was confirmed (11lt/d). Analytical: TSH: 1,19uU/ml; T4L: 0.87ng/dl; PRL: 23.10ng/ml; LH: 15.6mlU/ml; FSH: 6.15mlU/ml; E2: 299pg/ml; ACTH: 24.10pg/ml ; DHEAS: 114ug/dL; Cortisol 8am: 8.99ug/dl; IGF-1 : 64.2ng/ml (VN: 117-329), In Serum Cr, G, Calcium: normal; Ca in Urine: 140mg/d. A Water Restriction Test was carried out with a response to the administration of 10ug of Nasal Desmopressin, showing an increase in OsmU in more than 50% of the baseline. The pituitary MRI showed thickening of the pituitary stalk up to 8 mm and absence of the bright spot in T1 corresponding to the neurohypophysis. She did not accept the biopsy, deciding to administer Methylprednisolone 1gr EV daily for 3 days, in addition to desmopressin 1 puff bid, decreasing the urinary volume 1.5 - 2 liters/d and serum sodium: 137meq/L.
Discussion : AIH is an inflammatory disease that affects the pituitary gland that can be associated with neurological, ophthalmological and endocrinological manifestations. The clinical presentation is variable. Symptoms have been classified into four categories: a) compressive (occurring in 50-70%); b) hypopituitarism (66-97%); c) diabetes insipidus (27%), and d) hyperprolactinemia (rare). In most cases, the clinical history and characteristics of pituitary MRI (thickening of the pituitary stalk, absence of signal of neurohypophysis in T1) suggest the diagnosis. These signs in MRI and clinical characteristics were evidenced in the patient.
Conclusion : AIH is an uncommon situation whose temporal relationship with pregnancy should make us suspect its presence.
Jose PAZ-IBARRA– ENDOCRINOLOGIST, HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU, Lima, Lima, Peru
Victor Garcia– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru
Karla Salas– ENDOCRINOLOGY RESIDENT, HOSPITAL REBAGLIATI - LIMA - PERU, Peru
HOSPITAL NACIONAL EDGARDO REBAGLIATI - UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS. LIMA - PERU
Lima, Lima, Peru
PERUVIAN ENDOCRINOLOGIST, UNIVERSITY TEACHER, ACTIVE MEMBER OF AACE, AREAS OF INTEREST NEUROENDOCRINOLOGY, THYROID, ENDOCRINOLOGY OF REPRODUCTION AND BONE MINERAL METABOLISM
HOSPITAL REBAGLIATI - LIMA - PERU, Lima, Peru