Reproductive function in acromegalic women: a one-center experience
R Attanasio1, M Albizzi1, L Cortesi1, M Pagani1, M Montini2 & G Pagani1
Background: It is well-known that gonadal function is impaired in acromegalic females, due to several mechanisms.
Aim and design: Retrospective survey of our series.
Patients: Our electronic database encompassing data of 180 acromegalic patients collected over 30 years was searched, extracting first data of women (n=91) and then of females aged less than 50 years at diagnosis of acromegaly (n=34).
Results: Among the 34 women of potentially fertile age, 18 patients had had 28 pregnancies (24 singleton at term) before the diagnosis of acromegaly (group 1) and 9 patients had no pregnancy at all (group 2). Seven patients had 11 spontaneous pregnancies (9 at term, 2 twin) after the diagnosis of acromegaly (group 3): two conceived after non-curative surgery, 4 while on GH-suppressive treatment (3 on dopamine-agonists and 2 on somatostatin analogs), and the last without any treatment. One patient had 3 pregnancies before and one after the diagnosis. On comparing patients of groups 1 and 3, the former group was older (36 vs 28 years), with lower levels of GH at diagnosis (31 vs 83 ng/ml) and lower prevalence of hyperprolactinemia (4/18 vs 4/7) but without difference in adenoma size distribution (microadenoma vs intrasellar macroadenoma vs extrasellar adenoma). On comparing patients of groups 2 and 3, unexpectedly the former had lower levels of GH at diagnosis (32 vs 83 ng/ml) and lower prevalence of hyperprolactinemia (2/7 vs 4/7) but no difference in age and adenoma size was observed.
Conclusions: In our experience 20% of acromegalic patients conceived spontaneously in spite of ongoing disease. On considering that the diagnosis of acromegaly is often delayed by several years, at least a few pregnancies in patients of group 1 might be added to the total. Furthermore, patients can be reassured that even very high GH levels and extrasellar macroadenoma at diagnosis are not an absolute barrier to conception.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.