Endocrine Abstracts

Pregnancy in acromegalic patients is an infrequent event, but with earlier diagnosis and advanced surgical/medical management, more affected women get pregnant.

The use of Somatostatin analogues (SSA) during pregnancy seems safe, but there are few reported pregnancies under this treatment.

We report two acromegalic patients treated with SSA that became pregnant.

Case 1: Thirty-three year old woman diagnosed with acromegaly at the age of 31 (March 2008: IGF1: 901 ng/ml; Pituitary MR: intrasellar macroadenoma). She underwent two selective adenomectomies by transphenoidal route (April 2008; March 2009), without cure. Lanreotide, 120 mg – 6/6 weeks was prescribed since June 2008. At appointment (7/10/09) she referred a 12 weeks pregnancy and last Lanreotide injection at 19/8/09. SSA was discontinued. Pregnancy was uneventful and a full-term boy was born, with a normal postnatal development.

Case 2: The patient developed secondary amenorrhea and progressive enlargement of her hands/feet since age 24, 2 years after a normal pregnancy. In 2007, (33-year-old), acromegaly was diagnosed (invasive macroadenoma) that persisted after transphenoidal and transfrontal adenomectomy, (IGF1:912 ng/ml). In June 2008 after stereotaxic radiotherapy she began octreotide 30 mg 4/4 weeks. After 14 months (IGF1: 512 ng/ml) on evaluation for leucorrhea, a pelvic ultrasound revealed a 6 weeks pregnancy. She chooses to abort.

Conclusions: Case 1: although the embryo had been exposed to Lanreotide during the first trimester, pregnancy, fetal and postnatal development were uneventful. Despite reassuring reports in literature, it seems safest to discontinue SSA before or as soon as pregnancy is detected.

Case 2: pregnancy occurred despite prolonged amenorrhea. Women in fertile age should receive adequate contraception if treated with SSA, as it may improve fertility.

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.