Management of hypopituitarism during pregnancy in patients with PROP1-related combined pituitary hormone deficiency: Review of the literature with a case report

Background: The management of pregnancy in patients with combined pituitary hormone deficiency (CPHD) represents a unique challenge due to the complex interplay of multiple pituitary hormone deficiencies, higher risk of feto-maternal complications, and lack of established evidence-based clinical guidelines. Though improvements in assisted reproductive techniques (ART) and multidisciplinary care over the last decades have increasingly enabled successful pregnancies in hypopituitary women, genetic causes of CPHD are rarely identified and data on pregnancy outcomes in affected women are scarce, underscoring the need for further case documentation to better inform clinical practice. Aims: We describe the case of a woman with genetically confirmed PROP1-related CPHD who achieved and completed a successful pregnancy through ART and tailored endocrine management throughout gestation and the postpartum period. This case report highlights the importance of preconception counseling, careful hormone replacement, and close monitoring and collaboration among expert endocrinologists, obstetricians, and neonatologists to optimize maternal and fetal outcomes in women with genetic CPHD. Furthermore, we provide a comprehensive literature review exploring key issues related to the main clinical and therapeutic challenges in the management of hypopituitarism during pregnancy, and particularly in the context of CPHD.