Introduction: Pregnancy occurs relatively rare women with acromegaly. However, in recent years, pregnancy has become more likely to occur in acromegalic women possibly due to improvements in acromegaly treatment, and advanced assisted reproduction techniques.
Methods: In this case series, we retrospectively analyzed 11 pregnancies of 8 acromegalic women followed in the university hospital in a time range between 2009–2019. Data were obtained from patient files.
Results: The median age at the time of acromegaly diagnosis was 25.5 years (range: 18–29 yrs). All patients had macroadenoma at the time of diagnosis with a maximum median diameter of 22 mm. Surgery was the primary choice of treatment in all patients. Four women had a history of radiotherapy. The median duration of time between pituitary surgery and conception was 7 years, while acromegaly was diagnosed at the 12th month of lactation from previous delivery in one patient. The median GH and IGF-1 levels at the last visit before the detection of pregnancies were 1.5 ng/ml and 307 ng/ml respectively, and the median maximum diameter of residual pituitary adenoma was 6 mm. Only five out of 11 pregnancies were planned. Three of the five planned pregnancies occurred spontaneously while two occurred with in vitro fertilization. One patient was able to become pregnant at the third attempt of in vitro fertilization. In acromegalic women planning pregnancies, somatostatin analogs (n = 5) treatment were discontinued 17 months before conception. Six unplanned pregnancies occurred while patients were on somatostatin analogs (n = 6) treatment. Three out of six unplanned pregnancies reached term while two were terminated due to octreotide use, and one resulted in spontaneous abortion in the first trimester. Also one out of five planned pregnancies ended in the first trimester due to spontaneous abortion. No complications such as gestational diabetes and preeclampsia were observed in seven pregnancies reaching term, cesarean section being the method of delivery in all. No congenital anomaly was observed in the babies. Increase in adenoma size of one mm was noted in one patient only. Lactation did not occur after one out of these seven pregnancies.
Discussion: There is no consensus on the follow-up of pregnancies in women with acromegaly. It is usually recommended to discontinue medical treatment as soon as pregnancy is detected. Although a majority of pregnancies occurred in acromegalic women are reported to reach term without major complications, particular attention should be paid to these women regarding gestational diabetes, hypertension and apoplexy.
05 Sep 2020 - 09 Sep 2020