Lymphocytic hypophysitis in pregnancy complicated by intrahepatic cholestasis of pregnancy: a case report
10.3760/cma.j.cn113903-20220807-00757
- VernacularTitle:妊娠期淋巴细胞性垂体炎合并妊娠期肝内胆汁淤积症1例
- Author:
Jing LI
1
;
Yuhong SHANG
;
Yuan JI
;
Xiaohan JIN
;
Shuang LI
;
Bin YAN
Author Information
1. 大连医科大学附属第一医院妇产科，大连 116011
- Keywords:
Pregnancy complications;
Autoimmune hypophysitis;
Cholestasis, intrahepatic
- From:
Chinese Journal of Perinatal Medicine
2023;26(9):769-773
- CountryChina
- Language:Chinese
-
Abstract:
This paper reports the diagnosis and treatment of a case of lymphocytic hypophysitis in pregnancy complicated by intrahepatic cholestasis of pregnancy. The 32-year-old patient had regular menstrual cycles and conceived naturally. Around 24 weeks of gestation, she developed a headache without abnormalities in the visual field. Skin itching occurred at 32 weeks of gestation, but her headache was significantly relieved. By 33 +1 weeks of pregnancy, the patient experienced elevated total bile acid, transaminase, and hypoglycemia, leading to a diagnosis of intrahepatic cholestasis of gestation (mild). Subsequently, at 33 +6 weeks of gestation, her total bile acid increased substantially, and the disease progressed rapidly into intrahepatic cholestasis of pregnancy (severe). As a result, an emergency cesarean section was performed to terminate the pregnancy. The Apgar score of the newborn was five points at one minute and ten points at five minutes. Following the surgery, the patient showed no lactation and had symptoms such as nausea, vomiting, fatigue, and refractory hyponatremia. Blood hormone measurement showed hypopituitarism. An enhanced intracranial MRI showed pituitary enlargement and uniform enhancement. Consequently, the clinical diagnosis was lymphocytic hypophysitis. Treatment with glucocorticoids effectively alleviated the symptoms. Menstruation resumed after more than one month of delivery. The intracranial MRI in postpartum reexamination after six months of delivery revealed a disappearance of the lesion. The patient continued with oral glucocorticoid therapy.
