ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P701 | DOI: 10.1530/endoabs.63.P701

Acromegaly in a 29-year-old woman: restored fertility after surgery and radiosurgery

João Roque, Dinis Reis & Maria João Bugalho

Hospital de Santa Maria, Chuln, Lisboa, Portugal.

Acromegaly is a rare condition and is frequently associated with infertility. There are very few reported cases of pregnancy in these patients, particularly after surgery and radiosurgery. This is a case of a 29-year-old woman with a 1-year history of nasal obstruction, headache and amenorrhea. She was mother of a 5-year-old child and was trying to get pregnant again, unsuccessfully. Clinical examination revealed coarsening of the facial features, hand and feet enlargement, hypoacusis and bitemporal hemianopsia. No hypertension neither hyperglycemia were documented. Blood tests showed a marked elevation of Growth Hormone (GH 418 ng/mL, reference range 0–10) and Insulin-like Growth Factor 1 (IGF-1 796 ng/mL, reference range 117–329), establishing the diagnosis of Acromegaly. The Prolactine levels were in the upper limit of normality (PRL 28.8 ng/mL, reference range 2.8–29.0), and the remainder pituitary evaluation was normal, including the CRH, LH-RH and TRH stimulation tests. Cranial magnetic resonance imaging revealed a pituitary macroadenoma with left cavernous sinus extension and optic chiasm compression. Treatment with Octreotide was started and she underwent transphenoidal adenoma partial resection 2 months later, after which ophthalmological examination got progressively normal. At this time, treatment with Levothyroxine and Hydrocortisone was initiated. Nevertheless there was still biochemical and radiological evidence of disease. The patient underwent gamma-knife radiosurgery 4 months later. After that, GH and IGF-1 levels got reduced and became completely normal after 4 years. Few months after the intervention she restored menses. Then she got 3 uneventful pregnancies, the first of them 13 months after radiosurgery, and delivered at term 3 healthy babies. Facial and extremities features became softer. Octreotide and Hydrocortisone were suspended 2 years later. After 12 years she has no evidence of disease progression and is only medicated with Levothyroxine 50 mcg per day.

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