A 39-year-old woman presented with a progressive enlargement of her feet, hands, tongue, nose and ears, headaches, excessive sweating, weakness and infertility. She was diagnosed with acromegaly at the age of 36, but had initially refused any kind of treatment. For a period of 3 years, the size of pituitary adenoma had enlarged from 10×12×20 to 13×19×22 mm, and the level of GH had increased from 62.4 to 104 mU/I. Preoperative administration of somatostatin analogues was recommended.
At the course of treatment with lanreotide she conceived and decided to preserve pregnancy. Lanreotide was discontinued after pregnancy was confirmed. In the first trimester, her GH and IGF-1 were in the normal range, followed by gradual increase since the second trimester. No complications or visual impairment during gestation were observed, and a healthy female infant (weight 3560 g, length 52 cm) was delivered at term.
After delivery high levels of GH and IGF-1 without significant enlargement of adenoma were registered. When breast feeding was stopped, lanreotide treatment was resumed with marked effect: GH and IGF-1 levels have gradually dropped from 189 to 11.9 (reference range 0.213.0 mU/l) and from 1388 to 388 (reference range 101267 ng/ml) respectively. The patient continues to receive injections of lanreotide. The baby remains developmentally normal for 8 months of the follow-up.
There are few reported uncomplicated pregnancies in acromegalic women, having received depot somatostatin analogues at different stages of gestation period. We present a case of conception and successful pregnancy outcome in a 39-year-old woman with somatotropinoma, treated with lanreotide before and briefly during the first trimester of gestation.
03 - 07 May 2008
European Society of Endocrinology