Breastfeeding in panhypopituitarism: a case report, review of the literature, and management checklist
摘要
Panhypopituitarism is a rare endocrine disorder characterized by deficiency of multiple pituitary hormones. Because prolactin and oxytocin are essential for lactation, breastfeeding is often presumed to be impossible in affected women, and guidance on lactation in this population is scarce.
MethodsWe conducted a literature search to identify reports describing breastfeeding outcomes in women with hypopituitarism or panhypopituitarism and examined clinical, obstetric, and treatment-related factors (including prior pituitary surgery and radiation therapy) potentially associated with breastfeeding success.
Case studyWe report the case of a 34-year-old pregnant woman with panhypopituitarism in Israel who established and maintained a sustained partial breastfeeding relationship following delivery. Lactation support included intranasal oxytocin administered before each breastfeed, use of a homemade nursing supplementer, galactagogues, and regular pumping. Breastfeeding was maintained for 6.5 months with infant formula supplementation.
Results of literature reviewWe identified reports of lactation outcomes in 69 parous women with pituitary hormone deficiencies, 20 of whom were reported to have breastfed. In an exploratory multivariable logistic regression analysis incorporating demographic, medical, and labor-related variables, prior radiation therapy appeared to be associated with a lower likelihood of breastfeeding.
ConclusionsThis case and literature review suggest that breastfeeding may be possible in some women with panhypopituitarism, given individualized preparation and multidisciplinary support. The use of intranasal oxytocin in this context is hypothesis-generating and warrants further study. We propose a management checklist to assist clinicians in supporting individuals with panhypopituitarism who wish to breastfeed.
Clinical trial registrationNot applicable.