Background: Acromegaly is rarely encountered in pregnancy and the lack of data for clinical outcomes limits the development of evidence-based guidelines. We present the case of a pregnancy in a 31-year-old woman with acromegaly due to a pituitary microadenoma.
Clinical case: The patient underwent trans-sphenoidal hypophysectomy in 2015 at the age of 28, which was non-curative: post-operative IGF-1 was 533 mcg/l (72259 mcg/l) (down from 894 mcg/l preoperatively) and pituitary MRI showed a persistent pituitary mass (5×6×7 mm). She remained on hydrocortisone and attempts for a Short Synacthen Test had failed due to needle phobia. She became pregnant in late 2017. Her most recent IGF-1 level pre-pregnancy was 303 mcg/l and she remained symptomatic with sweats and soft tissue swelling at time of first endocrine review at 12 gestational weeks. As pregnancy progressed, her symptoms entirely resolved and IGF-1 levels fell to 21 mcg/l at week 13. IGF-1 levels rose progressively to 234 mcg/l at week 24 and 286 mcg/l at week 33 but she remained asymptomatic. Oral Glucose Tolerance Test was negative for gestational diabetes at week 24. She developed pre-eclampsia at week 35, and delivered a healthy girl at 39 weeks by spontaneous vaginal delivery. Blood pressure normalised after delivery and acromegaly symptoms remain under control. She is now off Hydrocortisone and is awaiting pituitary MRI once she has finished breastfeeding.
Conclusion: The growth hormone of placental origin gradually replaces the pituitary hormoneduring pregnancy. As a result, the IGF-1 declines during early pregnancy to increase later. The available experience regarding pregnancy in acromegaly is scant. The majority of the available data suggests that acromegaly remains stable during pregnancy, but the patients are at increased risk of gestational diabetes and hypertension. Hence, the management of these patients should be based on a multidisciplinary approach.