Antepartum Pituitary Insufficiency in Diabetes Mellitus

Pituitary infarction is a well-known consequence of postpartum hemorrhage and attendant hypotension (Sheehan's syndrome). Antepartum pituitary necrosis, however, is exceedingly rare, having been reported in only four women, all young diabetics. The clinical findings and laboratory data for three additional subjects who developed acute pituitary insufficiency during the latter part of pregnancy are reported. None experienced pre- or post-partum hemorrhage or hypotension, and all delivered viable, healthy babies. After delivery all women were amenorrheic, developed cold intolerance, and had either absent or inadequate lactation. Laboratory studies showed diminished levels of plasma growth hormone, luteinizing hormone, and follicle-stimulating hormone in all three subjects; in two there was a decreased radioactive iodine uptake and diminished base-line 17-hydroxysteroids and 17-ketosteroids. On replacement therapy the three women have remained in relatively good health for 8 to 15 years after pituitary infarction. Early recognition and appropriate therapy are vital to the health of the mother and fetus in this unusual syndrome.