Axis-Specific Peripartum Management for Radiation-Induced Panhypopituitarism With Arginine Vasopressin Deficiency: A Case Report

Background/Objective: We report the perinatal course and practical, axis-specific management of a 34-year-old woman with panhypopituitarism and arginine vasopressin deficiency (AVP-D) consequent to cranial irradiation and ifosfamide, cisplatin, and etoposide chemotherapy for a germinoma who conceived via in vitro fertilization. Case Report: Care was organized by endocrine axis with coordinated obstetric collaboration. Subcutaneous growth hormone was discontinued upon pregnancy confirmation. Central hypothyroidism was managed using free thyroxine targets with trimester-appropriate oral levothyroxine dose adjustments. Secondary adrenal insufficiency was addressed with oral hydrocortisone and a predefined intrapartum stress-dose intravenous hydrocortisone plan. AVP-D was managed by continuing oral desmopressin with symptom-guided monitoring. Labor was electively induced at term, and the peripartum course was uncomplicated. Maternal and umbilical cord endocrine profiles at delivery were documented to contextualize axis physiology. The newborn had reassuring adaptation and normal early pediatric assessments. Discussion: This case illustrates that a pragmatic, axis-wise strategy centered on free thyroxine-guided thyroid replacement, explicit glucocorticoid stress coverage, and disciplined AVP-D monitoring can be safely implemented in collaboration with reproductive medicine and obstetrics after cranial irradiation and ifosfamide, cisplatin, and etoposide chemotherapy. Conclusion: A reproducible, axis-specific pathway may support safe pregnancy and delivery in women with complex pituitary sequelae, provided that monitoring plans and intrapartum stress-dose coverage are defined in advance.