How is hypopituitarism in pregnancy managed
Because fertility is usually impaired in women with pituitary insufficiency, they rarely have spontaneous pregnancies.
• ACTH deficiency: Hydrocortisone, which does not cross the placenta, should be the drug of choice. Higher doses may be required (20%–40% more), particularly during the third trimester. Dexamethasone, which is not inactivated in the placenta, should be avoided. Pregnant patients should be closely monitored for clinical manifestations of glucocorticoid under- and overreplacement. Stress dosing is recommended during the active phase of labor.
• TSH deficiency: Serum TSH levels cannot be used to adjust thyroid replacement dosing in patients with central hypothyroidism. Serum free T 4 , obtained before the LT 4 dose, should be used instead. The target free T 4 level should be in the mid to upper half of the reference range.
• GH deficiency: Because there are no prospective studies evaluating the efficacy and safety of GH therapy during pregnancy, and the fact that the placenta synthetizes GH, GH replacement therapy should be discontinued during pregnancy.