HYPOPHYSECTOMY DURING PREGNANCY IN A PATIENT WITH CANCER OF THE BREAST: CASE REPORT WITH HORMONE STUDIES*

Abstract

Primary hypophysectomy and radiation therapy to the breast were decided upon as treatment for a woman with metastatic mammary cancer, first Seen when 26 weeks pregnant. Replacement therapy for the duration of pregnancy (except for four days in week 32) consisted of 75 mg. of cortisone and 90 mg. of thyroid daily. Delivery was induced at 35 weeks because of premature labor and hormonal evidence of placental deficiency. Labor progressed normally without oxytocic stimulation. A normal 5-pound infant was delivered. There was no mammary secretion post partum. Pitressin, which had been required for control of diabetes insipidus after hypophysectomy, was no longer needed. Twelve days post partum, pneumonitis developed and terminated in death four weeks later. Autopsy revealed an organizing pneumonitis of both lungs involving all lobes. The only residual cancer consisted of islets of poorty differentiated cells in the fibrous stroma of one small axillary node. There was no residual pituitary tissue. Hypophysectomy per se did not affect placental function as determined by the urinary excretion of chorionic gonadotropin, estrogens and pregnancdiol. Aldosterone excretion, serum thyroxine-binding protein concentration and the electrophoretic pattern of serum were likewise unaffected. At 31 weeks there was no clinical evidence that replacement therapy was inadequate, but studies of serum PBI levels, of corticosteroid metabolism, and of glucose and insulin tolerance indicated a deficiency. When cortisone was stopped for two days and thyroid for four days, clinical signs of acute adrenal insufficiency appeared and were accompanied by chemical evidence of complete lack of endogenous adrenocortical hormone. This episode was followed by urinary findings indicative of placental failure and then bjr premature uterine contractions. Also observed was a drop in the level of serum total proteins, with lowered albumin and elevated gamma globulin ratios. There was continued chemical evidence of adrenal insufficiency. In the early postpartum period, during cortisone and thyroid therapy, the signs of adrenal insufficiency disappeared, glucose tolerance became normal, and an insulin tolerance test elicited the expected reaction.