Těhotenství a porod po traumatickémpanhypopituitarismu

Pregnancy and Labor after Post-traumaticPanhypopituitarism

Objective:
We describe a case of 23 years old woman who, with a history of car accident at the age of11 and severe head injury, attended our Center of Reproductive Medicine complaining of primaryinfertility. The accident preceded menarche and the development of inner genitalia (uterus 46 mm,cervix:corpus ratio 1 : 1) as well as secondary sexual development was not fully accomplished.Ovarian failure was accompanied by amenorrhea, if not substituted. Under replacement therapyregular menstruation was established. Basal hormonal levels was extremely low(FSH and LH0.2-0.3IU/l, PRL 0.5 ng/ml, estrogens 0.08 nmol/l, PRGE was not detected). With oral administration ofmicronized estradiol (Check et al., 2001) endometrial thickness of 9 mm was achieved. All of fiveretrieved oocytes were fertilized with partner sperm (normospermy) and three embryos weretransferred. Already the first attempt was successful. Patient suffered with transitional anorexiaand vomiting which could be handled conservatively. Hormonals level were normal. Patient substitutedwith Hydrocortison and Euthyrox. On January 2, 2003 the pregnancy was finished bycaesarian section, one week before the delivery term (girl, 2970, Apgar score 10-10-10).Design: Case report.Setting: Center of Reproductive Medicine, Zlin.Conclusion: This care report demonstrates that recent progress in assisted reproduction fieldenables to manage successfully even exceptional pathological conditions.

Key words:
post-traumatic panhypopituitarism, oocyte donor, delivery