What happens to the pituitary gland
The pituitary gland is a small gland at the base of the brain that controls the thyroid, adrenal glands, ovaries and milk production. During pregnancy, its anterior lobe almost doubles in size due to cells that produce prolactin, but the blood supply hardly grows. The gland finds itself in a vulnerable position. If massive blood loss occurs during childbirth or immediately after it with a sharp drop in pressure, blood flow to the pituitary gland is critically reduced and some cells die. Over time, scar tissue or an empty sella turcica forms in their place.
- Enlargement of the pituitary gland during pregnancy
- Massive blood loss and pressure drop
- Ischemic necrosis of the anterior lobe
- Gradual formation of an empty sella turcica
- Loss of function of several hormonal axes
- The posterior lobe is rarely affected
Symptoms and their order
Usually the functions most dependent on pregnancy are lost first. Lack of milk or its rapid disappearance is the earliest sign that is often ignored. Then the menstrual cycle is not restored, libido decreases, and dry mucous membranes appear. Gradually, manifestations of a lack of thyroid hormones are added: chilliness, drowsiness, swelling, constipation, slowness. A deficiency of adrenal hormones gives the most dangerous picture: weakness, decreased blood pressure, nausea, loss of appetite and weight, and a tendency to faint. Hair loss in the armpits and pubic area is also typical.
- Absence or rapid cessation of lactation
- Lack of menstruation after childbirth
- Weakness, fatigue, low blood pressure
- Chilliness, drowsiness, swelling, dry skin
- Decreased libido and dry mucous membranes
- Loss of axillary and pubic hair
- Pale skin and tendency to low sugar
- Memory and mood disorders
What tests are needed
The hormones of the pituitary gland are assessed together with the hormones of the target organs: only in such a pair can it be seen exactly where the breakdown is. The key point is that in this disease, TSH may remain normal or low, and free T4 may be reduced, so measuring TSH alone is not enough. Be sure to check morning cortisol; if the values are borderline, the endocrinologist prescribes stimulation tests. Prolactin, LH, FSH, estradiol are determined. The picture is complemented by MRI of the pituitary gland: a reduced gland or an empty sella turcica is often detected. It is important to exclude other causes of hypopituitarism.
- Morning cortisol, stimulation tests if necessary
- TSH together with free T4
- Prolactin
- LH, FSH, estradiol
- Complete blood count, sodium, glucose
- MRI of the pituitary gland
- Exclusion of pituitary tumor and lymphocytic hypophysitis
Treatment
Treatment consists of replacing the missing hormones, and the order here is fundamental: first, the deficiency of adrenal hormones is compensated, and only then therapy with thyroid hormones is started, otherwise a sharp deterioration in the condition is possible. The dosage is selected by the endocrinologist based on how you feel and tests. Women of reproductive age with loss of sexual function are prescribed sex hormone replacement therapy until the age of natural menopause. Lifelong treatment. Separately, they teach the rules of behavior in case of illness, injury or surgery, when the need for adrenal hormones increases.
- Adrenal hormone replacement first
- Thyroid hormone therapy thereafter
- Sex hormone replacement therapy
- Increasing the dose in case of illness, surgery, injury according to the doctor’s regimen
- Patient card indicating diagnosis
- Regular monitoring of tests and well-being
- Pregnancy planning together with an endocrinologist and gynecologist
Prevention and prognosis
The main prevention is high-quality management of labor and rapid stoppage of bleeding, as well as timely replacement of blood loss. For a woman who has had a difficult birth with massive blood loss, it makes sense to talk to her doctor about having her hormones checked after a few months, especially if her period has not returned or if unexplained weakness persists. With an established diagnosis and properly selected therapy, the prognosis is good: performance and quality of life are restored. Pregnancy is possible, but requires preparation and supervision by an endocrinologist together with an obstetrician-gynecologist.
- Prevention and timely treatment of postpartum hemorrhage
- Checking hormones after a difficult birth if there are complaints
- Early diagnosis prevents adrenal crisis
- Lifelong observation by an endocrinologist
- Training in the rules for increasing dosage under stress
- Pregnancy planning under the supervision of specialists
