Postpartum hypopituitarism with preservation of the pituitary-ovarian axis

An 18-year-old woman developed postpartum hypopituitarism, presenting with personality and behavioral changes caused by severe hypoglycemia. In spite of well-documented deficiencies of thyroxine, cortisol, and growth hormone, she maintained normal ovarian function (reflected by normal menstrual cycles, normal estrogenization on examination, and normal FSH and estradiol levels). Classically, gonadal failure occurs very early in the course of pituitary failure, prior to loss of thyroid or adrenal function; preserved ovarian function is commonly used as clinical evidence of intact pituitary function. This patient emphasizes the importance of pursuing the possibility of pituitary disease in appropriate clinical settings, even in patients with intact ovarian function.