Acromegaly, pregnancy and diabetes mellitus a successful maternal and foetal outcome
SS Seshadri, D Wright, DC Whitelaw & SR Peacey
There are at least 60 reports of pregnancy and acromegaly. The maternal and foetal morbidity relates to associated diabetes mellitus and hypertension rather than maternal growth hormone excess. A 32-year-old Asian female who spoke no English, was noted to have acromegalic features during a hospital admission for pneumonia. She was 6 weeks pregnant and had been recently diagnosed with type 2 diabetes mellitus. Acromegaly was confirmed with GH nadir 105 mU/l during 75 g OGTT and serum IGF1 - 115 nmol/l (NR 1565 nmol/l). A short synacthen test was normal with peak cortisol at 30 minutes of 661 nmol/l. Clinically she was hypothyroid and free T4 - 11.9 pmol/l (NR 10 25 nmol/l) and TSH <0.05 mU/l. She was treated with thyroxine 125 mcg daily and her twice daily insulin regimen continued. Visual fields were full on formal testing. Pituitary MRI scanning was delayed because of pregnancy and performed at week 20. A macroadenoma was confirmed (3.6×3.1×3.0 cm) abutting the optic chiasm. Very close monitoring of visual fields continued without visual deterioration. Glycaemic control remained excellent with mean HbA1c 5.8%. No hypertension observed. Growth and development of the foetus during pregnancy was normal. Elective LSCS occurred at 38 weeks where a 2.72 kg healthy baby was delivered. Transsphenoidal surgery was undertaken 6 months following childbirth. Post operatively GH levels remained elevated with mean GH 30 mU/l and IGF-1 raised at 113 nmol/l. In summary this case illustrates a successful maternal and foetal outcome during pregnancy in a patient with severe growth hormone excess when managed conservatively by a multidisciplinary approach.