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.
Twelve women with acromegaly who completed pregnancy were identified from centres involved in the Irish Pituitary Study. Eleven women had pituitary macroadenomas and one woman had a microadenoma. Only 5/17 pregnancies had optimal biochemical control of acromegaly preconception, as defined by IGF-1 concentration in the age-related reference level and plasma GH concentration of <2 μg/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 preconception normalised during pregnancy. There was a reduction in plasma IGF-1 concentrations, though not into the normal range, in a further two 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 C-section at 35 weeks’ 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.
GrynbergMSalenaveSYoungJChansonP.Female gonadal function before and after treatment of acromegaly. Journal of Clinical Endocrinology and Metabolism2010954518–4525. (https://doi.org/10.1210/jc.2009-2815)
KatznelsonLLawsERJrMelmedSMolitchMEMuradMHUtzAWassJA & Endocrine Society. Acromegaly: an Endocrine Society Clinical Practice guideline. Journal of Clinical Endocrinology and Metabolism2014993933–3951. (https://doi.org/10.1210/jc.2014-2700)
JalladRSShimonIFraenkelMMedvedovskyVAkirovADuarteFHBronsteinMD.Outcome of pregnancies in a large cohort of women with acromegaly. Clinical Endocrinology201888896–907. (https://doi.org/10.1111/cen.13599)
Ribeiro de Oliveira Longo SchweizerJRibeiro-OliveiraAJrBidlingmaierM.Growth hormone: isoforms, clinical aspects and assays interference. Clinical Diabetes and Endocrinology2018418. (https://doi.org/10.1186/s40842-018-0068-1)
CaronPBroussaudSBertheratJBorson-ChazotFBrueTCortet-RudelliCChansonP.Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women. Journal of Clinical Endocrinology and Metabolism2010954680–4687. (https://doi.org/10.1210/jc.2009-2331)
ChengSGrassoLMartinez-OrozcoJAAl-AghaRPivonelloRColaoAEzzatS.Pregnancy in acromegaly: experience from two referral centers and systematic review of the literature. Clinical Endocrinology201276264–271. (https://doi.org/10.1111/j.1365-2265.2011.04180.x)
GiustinaABarkanACasanuevaFFCavagniniFFrohmanLHoKVeldhuisJWassJVon WerderKMelmedS.Criteria for cure of acromegaly: a consensus statement. Journal of Clinical Endocrinology and Metabolism200085526–529. (https://doi.org/10.1210/jcem.85.2.6363)
JosephKSFaheyJPlattRWListonRMLeeSKSauveRLiuSAllenACKramerMS.An outcome-based approach for the creation of fetal growth standards: do singletons and twins need separate standards?American Journal of Epidemiology2009169616–624. (https://doi.org/10.1093/aje/kwn374)
CaronPJBevanJSPetersennSFlanaganDTabarinAPrevostGMaisonobePClermontA & PRIMARYS Investigators. Tumor shrinkage with lanreotide autogel 120 mg as primary therapy in acromegaly: results of a prospective multicenter clinical trial. Journal of Clinical Endocrinology and Metabolism2014991282–1290. (https://doi.org/10.1210/jc.2013-3318)
WiesliPZwimpferCZapfJSchmidC.Pregnancy-induced changes in insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein 3 (IGFBP-3), and acid-labile subunit (ALS) in patients with growth hormone (GH) deficiency and excess. Acta Obstetricia and Gynecologica Scandinavica200685900–905. (https://doi.org/10.1080/00016340600676532)
YangMJTsengJYChenCYYehCC.Changes in maternal serum insulin-like growth factor-I during pregnancy and its relationship to maternal anthropometry. Journal of the Chinese Medical Association201376635–639. (https://doi.org/10.1016/j.jcma.2013.07.004)
StoneJCClarkJCuneoRRussellAWDoiSA.Estrogen and selective estrogen receptor modulators (SERMs) for the treatment of acromegaly: a meta-analysis of published observational studies. Pituitary201417284–295. (https://doi.org/10.1007/s11102-013-0504-2)
BellantoniMFVittoneJCampfieldATBassKMHarmanSMBlackmanMR.Effects of oral versus transdermal estrogen on the growth hormone/insulin-like growth factor I axis in younger and older postmenopausal women: a clinical research center study. Journal of Clinical Endocrinology and Metabolism1996812848–2853. (https://doi.org/10.1210/jcem.81.8.8768841)
Dawson-HughesBSternDGoldmanJReichlinS.Regulation of growth hormone and somatomedin-C secretion in postmenopausal women: effect of physiological estrogen replacement. Journal of Clinical Endocrinology and Metabolism198663424–432. (https://doi.org/10.1210/jcem-63-2-424)
PurdyJMMcAvoyHCotterN.Breastfeeding on the Island of Ireland Dublin: Institute of Public Health in Ireland 2017. Accessed at https://www.publichealth.ie/document/iph-report/breastfeeding-island-ireland
BigazziMRongaRLancranjanIFerraroSBranconiFBuzzoniPMartoranaGScarselliGFDel PozoE.A pregnancy in an acromegalic woman during bromocriptine treatment: effects on growth hormone and prolactin in the maternal, fetal, and amniotic compartments. Journal of Clinical Endocrinology and Metabolism1979489–12. (https://doi.org/10.1210/jcem-48-1-9)
RicciEParazziniFMottaTFerrariCIColaoAClavennaARocchiFGangiEParacchiSGasperiMet al. Pregnancy outcome after cabergoline treatment in early weeks of gestation. Reproductive Toxicology200216791–793. (https://doi.org/10.1016/S0890-6238(02)00055-2)
ColaoAAbsRBarcenaDGChansonPPaulusWKleinbergDL.Pregnancy outcomes following cabergoline treatment: extended results from a 12-year observational study. Clinical Endocrinology20086866–71. (https://doi.org/10.1111/j.1365-2265.2007.03000.x)