Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.
Mark Sherlock and Chris J Thompson
Anne Marie Hannon, Triona O'Shea, Claire Thompson, Mark J Hannon, Rosemary Dineen, Aftab Khalid Khattak, James Gibney, Domhnall O'Halloran, Steve Hunter, Chris J Thompson and Mark Sherlock
Pregnancy is rarely reported in acromegaly. Many patients are diagnosed in later life and younger patients may have subfertility due to hypopituitarism. We present a case series of 17 pregnancies in 12 women with acromegaly.
12 women with acromegaly who completed pregnancy were identified from centres involved in the Irish Pituitary Study. 11 women had pituitary macroadenomas, one woman had a microadenoma. Only 5/17 pregnancies had optimal biochemical control of acromegaly pre-conception, as defined by IGF-1 concentration in the age related reference level and plasma GH concentration of <2ug/L. In 6/17 pregnancies, dopamine agonist treatment was continued during pregnancy; all other acromegaly treatments were discontinued during pregnancy.
Effect of pregnancy on acromegaly; No patient developed new visual field abnormalities, or symptoms suggestive of tumour expansion during pregnancy. In 9/12 patients, plasma IGF-1 concentrations that were elevated pre-conception normalized during pregnancy. There was a reduction in plasma IGF-1 concentrations, though not into the normal range, in a further 2 pregnancies.
Effect of acromegaly on pregnancy; 15 healthy babies were born at term; one patient underwent emergency C-section at 32 weeks, for pre-eclampsia and one twin pregnancy had an elective caesarean section at 35 week’s gestation. Blood pressure remained within normal limits in the remainder of the pregnancies. Gestational diabetes did not develop in any pregnancy.
Our data suggests that pregnancy in women with acromegaly is generally safe, from a maternal and foetal perspective. Furthermore, biochemical control tends to improve despite the withdrawal of somatostatin analogue therapy during pregnancy.