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Latent pregnancy-associated hypopituitarism accompanied by chronic thyroiditis and limited scleroderma, revealed by the breakout of adrenal insufficiency 42 years after delivery

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Author(s): Shuzo Kaneko | Manabu Shiozaki | Nariko Omori | Shinji Tsuruta | Hitomi Haraoka | Yusuke Tsukamoto

Journal: Endocrinology Studies
ISSN 2038-9515

Volume: 3;
Issue: 1;
Start page: e5;
Date: 2013;
Original page

Keywords: pregnancy-associated hypopituitarism | empty sella | adrenal insufficiency | chronic thyroiditis | limited scleroderma

ABSTRACT
Pregnancy-associated hypopituitarism (PAH) has been referred to as Sheehan’s syndrome and lymphocytic hypophysitis, both of which are occasionally disclosed several decades after delivery. We report the rare case of a 70-year-old woman diagnosed with PAH with empty sella 42 years after her second delivery; she had had an episode of hypovolemic shock during her second delivery. She had been referred to our hospital because of the emergence of non-sustained ventricular tachycardia and symptoms of appetite loss and general fatigue accompanied by hyponatremia, hypoglycemia, and hypothyroidism. Hypopituitalism and secondary adrenal insufficiency had been revealed after her hospitalization. She had suffered from Raynaud’s syndrome for the past several decades. Our testing revealed that the patient had autoantibodies for thyroid peroxidase, thyroglobulin, and centromere, indicating the diagnosis of chronic thyroiditis and limited scleroderma. Her series of symptoms had been treated successfully by hydrocortisone and thyroid hormone replacement therapy. To the best of our knowledge, latent PAH accompanied by limited scleroderma have not been described in the international literature to date though quite a few latent cases may exist. We assume that some autoimmune mechanism during the perinatal period may possibly be a common step in the pathogenesis of PAH, chronic thyroiditis and limited scleroderma.
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