Case Study: Denise always hoped for another baby

DENISE Russell began to feel physically unwell shortly after giving birth to her son Jamie in August 2012.
Case Study: Denise always hoped for another baby

She was 32 years old and had been previously healthy.

“I lost four stone in three months and I felt terrible. I remember one of the nurses that I met in the hospital when I went to see Dr Ryan phoning him to say she thought I was on the way out.

“My husband Paul and my GP, Dr Mike O’Doherty in Killarney, were great in terms of supporting me.

“Dr O’Doherty referred me to Dr Ryan for investigations as he knew there was an underlying medical problem.”

James Ryan, a consultant endocrinologist and general physician, was immediately concerned that Denise had an issue with her pituitary gland.

“Denise had a pale grey colouring, was underweight and looked dehydrated. We immediately admitted her to hospital and confirmed that her body had stopped making sufficient cortisol, which is our innate steroid essential for maintaining immune function, energy storage and overall wellbeing,” he says.

“An MRI scan showed abnormalities of Denise’s pituitary gland that were in keeping with our clinical diagnosis of an under-functioning gland.”

The pituitary gland sits at the base of our brains and is described as the ‘master gland’ in terms of controlling our body’s hormones.

Further testing confirmed that Denise’s entire gland was malfunctioning due to a rare disorder known as lymphocytic hypophysitis.

“This is a rare condition where one’s immune system attacks the pituitary gland. In the short term, the priority was to replace the hormones Denise was missing. This involved taking tablets to replace her cortisol, thyroid and oestrogen hormones, as well as injections of growth hormone,” says Dr Ryan.

“Professor Chris Thompson in Beaumont Hospital was as always very helpful in organising a multi-disciplinary review of Denise’s scans and case in order to confirm our diagnosis and treatment plan were correct.”

Denise had always hoped to have another baby and, when she had physically recovered sufficiently, broached the subject with Dr Ryan.

“While not ruling anything out, Dr Ryan did advise me that it might be difficult in terms of both getting pregnant and also my body being able to support a pregnancy successfully,” she says.

Denise’s medical regime was adjusted in order to optimise her chances of conception.

“Dr Ryan advised me to contact him as soon as I confirmed I was pregnant because I would need significant medical back-up in the event I had good news.”

Denise found out she was pregnant in December 2015 and contacted Dr Ryan that day.

“Dr Ryan arranged to see me the next day and had arranged my ante-natal care in conjunction with his colleagues in Cork University Maternity Hospital.”

Denise and Paul’s daughter Caoimhe was born in August and Jamie is delighted with his baby sister.

“Again we had great help from our colleagues Professors Louise Kenny and Richard Greene in caring for Denise throughout her pregnancy. We had to adjust her hormonal regimen during the pregnancy and around delivery to ensure the health of both Denise and Caoimhe,” says Dr Ryan.

Denise continues to visit Dr Ryan for check-up and adjustment of her hormonal replacement requirements.

A busy mother of two, she feels well and hopes to return to work in the near future.

Cases of infertility are on the rise and can be quite stressful for all involved.

“Denise is a very positive person and it is great for the Russell family that such a happy day came to pass after Denise’s illness,” says Dr Ryan.

“It is rewarding for us also to see medical interventions producing such a positive outcome and illustrates the benefit of good communications between patients, GPs and the different consultants required to co-ordinate complex cases such as that of Denise’s.

“If a couple is having difficulty conceiving, I would advise visiting the family GP for assessment and initial testing. Referral to an obstetrician/gynaecologist or an endocrinologist may be indicated in some cases.”

Dr Ryan’s areas of interest include diabetes mellitus, endocrine disorders including thyroid and other hormonal problems, general internal medicine and sports medicine. or phone 021 601 3304

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