A 34 year-old woman with a seven-year prior history of the use of oral contraceptives containing estradiol and progestin is unable to maintain a viable pregnancy. On two occasions over the past 14 months, positive urine pregnancy tests are obtained, but the patient has miscarried within nine weeks of her previous menstrual cycle.
She presents to her obstetrician with a third suspected pregnancy, which is confirmed with elevated levels of both urine and serum measurements of human chorionic gonadotropin (hCG). Further laboratory testing shows this hormonal pattern:
Cast Study #1 | Hormone | Patient Result | Reference Interval |
| Progesterone | 8.4 ng/mL | 11 – 44 ng/mL |
| LH | 0.7 IU/L | 0.7 – 12.9 IU/L |
| FSH | 1.4 IU/L | 1.4 – 8.9 IU/L |
| Prolactin | 4.4 ng/mL | 4.8 – 23.3 ng/mL |
| TSH | 0.25 mIU/L | 0.3 – 4.2 mIU/L |
The obstetrician notes that progesterone levels are not elevated, as they should be to help maintain a viable pregnancy. The corpus luteum should continue to produce progesterone after implantation. However, the lack of pituitary secretion of LH is identified as the primary cause for the low subsequent production of progesterone, needed for the thickening of the uterine wall to nourish the implanted fertilized ovum.
All pituitary hormones measured are low or low-normal, which indicates hypoproduction of each of these hormones produced in the adenohypophysis. This condition is known as "panhypopituitarism". The underlying cause for the panhypopituitarism cannot be explored during the pregnancy, but will require assessment post-partum, especially TSH and thyroid function.
The patient is treated with progesterone injections to help fortify the implantation of the blastocyst into the uterine wall, and is monitored weekly with serum levels of hCG, which should continue to rise if the pregnancy remains viable.
Thyroid hormones are also monitored to assure adequate levels to support fetal development during pregnancy.
