A clinical case report of an successful spontaneous pregnancy in acromegaly
F. Mohammadi, S. Sadri, M. Hedayati Omami & N. Amini
Introduction: Acromegaly is a clinical condition results from GH hypersecretion which is usually elaborated by a somatotroph adenoma. Mass effect of adenoma and resulting hormonal changes impair fertility during pregnancy, estrogen-mediated pituitary enlargement along with enhanced pituitary vascularity is a true risk for tumor hemorrhage.
Case presentation: The 28-years-old patient first visited by the endocrinologist in 2004 for secondary amenorrhea and increased GH level. She was married in 1999 and had a successful spontaneous pregnancy in 2000. She stayed amenorrheic for 5 years after delivery until she made an appointment with the gynecologist. The gynecologist noticed the early clinical and para-clinical features of acromegaly and referred her to the endocrinologist. Radiographic and lab results indicated an active pituitary adenoma. Prednisolone and levothyroxine started and 3 months later trans-sphenoidal surgery performed for tumor resection. Eight months later after surgery neither IGF1 nor GH decreased, so octreotide was prescribed and patient was sent for gamma knife therapy on November 2006. Four months after gamma therapy while she was still taking octreotide, she was became amenorrheic again. Work up started and revealed the pregnancy. Octerotide discontinued. Visual field assessments were normal and MRI did not show any changes in the tumor size. Treatment continued with bromocriptine and levothyroxine. Prednisolone replaced by hydrocortisone stayed under close observation till term. GH, IGF1, and prolactine levels were monitored every 3 months during pregnancy. Suppression test with 100 g glucose were performed. Results were in normal range. MRI in 6th month of pregnancy, revealed slight decrease in the size of tumor. Blood pressure was normal. At the end of 8th month of pregnancy, IGF1 returned to its normal level. Serial sonographies did not reveal any abnormalities. Lipid profile and BS were normal. In 39th week of pregnancy, C/S performed for delivery. The female newborn was healthy.
Discussion: Today with advent of advanced surgical and medical management of these patients, increasing numbers could have successful pregnancy and child bearing.
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.