RESUMEN
OBJECTIVE: To report the first case of pregnancy and spontaneous delivery after total hypophysectomy. DESIGN: A case report. SETTING: University hospital. PATIENT(S): A 34-year-old woman with panhypopituitarism after hypophysectomy in childhood for craniopharyngioma. INTERVENTION(S): Successful fertility treatment followed by sufficient hormone substitution therapy during pregnancy. MAIN OUTCOME MEASURE(S): Clinical variables. RESULT(S): The patient had an uncomplicated spontaneous delivery without any substitution of oxytocin before, during, or after delivery. CONCLUSION(S): Normal pregnancy and delivery are possible in women with lack of pituitary function. Maternal pituitary oxytocin release seems to play a limited role in the onset and progression of labor.
Asunto(s)
Terapia de Reemplazo de Estrógeno , Hipofisectomía , Embarazo , Adulto , Craneofaringioma/radioterapia , Craneofaringioma/cirugía , Desamino Arginina Vasopresina/uso terapéutico , Femenino , Hemostáticos/uso terapéutico , Humanos , Hidrocortisona/uso terapéutico , Masculino , Inducción de la Ovulación , Resultado del Embarazo , Tiroxina/uso terapéuticoRESUMEN
BACKGROUND: High intensity focused ultrasound (HIFU) is a novel method which offers the non-invasive ablation of tissues without harming overlying organs or skin. It has been introduced successfully in urology for the ablation of prostatic hyperplasia and seems to be promising in the treatment of uterine fibroids. In this study we aimed to examine the feasibility and possible side effects of HIFU treatment of uterine tissues using an experimental mobile HIFU unit with ultrasound guidance. METHODS: For these experiments, a 1.07 MHz ultrasound source was used which allows treatment depths between 0 and 10 cm. In 12 patients scheduled to have abdominal hysterectomy, 5-60 impulses of HIFU were applied through the intact skin upon uterine tissues directly prior to the surgical procedure. Tissue intensities lay between 3,200 and 6,300 W/cm(2) and a fixed pulse length of 4 s was used. RESULTS: No side effects were encountered other than one first-degree skin burn and the treatment was well tolerated. Histology showed clearly demarcated coagulative necrosis in the targeted tissues. Treatment was concluded in less than 45 min for each patient. CONCLUSION: Focused ultrasound is an effective method to selectively destroy tissue within the uterus and the transabdominal access route is very feasible. This study shows that a mobile ultrasound source can be used safely and effectively to destroy uterine tissues, such as fibroids, without major side effects.