Endocrine Abstracts (2009) 19 P268

Two successful pregnancies in partially treated acromegaly followed by spontaneous improvement of GH axis postpartum

P Pusalkar & M Prentice

Mayday University Hospital, Croydon, UK.

We describe the case of a 39-year-old lady who was diagnosed with acromegaly in 1997 with basal GH 89.9 mu/l with paradoxical rise to 152 mu/l on OGTT, her IGF-1 was 76 nmol/l refrange (9.5–45). She underwent transphenoidal hypophysectomy in 1998 for pituitary microadenoma and postoperatively her growth hormone level was 5 mu/l. Six months following surgery she had an OGTT during which she suppressed her growth hormone levels to a nadir of 5 mu/l and her IGF-1 was 46.1 nmol/l. After positive octreotide test she started sandostatin LAR 20 mg IM 6 weekly and suppression of GH to < 0.6 mu/l.

As she wished to conceive her sandostatin was stopped after a total of 4 years because of limited safety data in pregnancy. Pregnancy followed 4 months later and her mean GH was 4.2 mu/l and IGF-1 was normal. She was closely followed up with regular visual field checks and IGF-1 to a normal delivery. Six months postpartum an OGTT showed suppression of GH to a nadir of 2.9 mu/l with an IGF-1 of 50.5 nmol/l. She wished a second pregnancy and so did not receive any therapy. 18 months later she conceived and the course of second pregnancy was uncomplicated with IGF-1 level in the normal range. Following the successful outcome of her second pregnancy she had suppression of GH to a nadir of 0.9 mu/l on OGTT and a mean GH of 1.05 mu/l. Her IGF-1 is in the normal range. This reflects an improved GH suppression almost to normal after 2 pregnancies and she remains off treatment.

Only limited data are available about pregnancy in acromegaly, few cases are reported in the literature. This case demonstrates normal pregnancy in mild acromegaly with improvement in GH axis postpartum which remains unexplained.

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