Acromegaly and Pregnancy

Abelove, William A.; Rupp, J. J.; Paschkis, K. E.

doi:10.1210/jcem-14-1-32

Cited by 52 publications

(11 citation statements)

References 5 publications

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“…In nearly 180 cases reported (excluding a historical review with 34 cases with scarce data to be properly analyzed) (62), only six patients with acromegaly required surgery during pregnancy. Of note, four of them had acromegaly diagnosed during gestation, and the reasons for surgery were increased intracranial pressure (48), apoplexy (53) and visual loss (3,58,60,63).…”

Section: Effect Of Pregnancy On Tumor Growth In Acromegalymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

Abucham

Bronstein

Rodrigues

2017

European Journal of Endocrinology

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Although fertility is frequently impaired in women with acromegaly, pregnancy is apparently becoming more common due to improvement in acromegaly treatment as well as in fertility therapy. As a result, several studies on pregnancy in patients with acromegaly have been published in recent years adding new and relevant information to the preexisting literature. Also, new GH assays with selective specificities and the knowledge of the expression of the various GH genes have allowed a better understanding of somatotrophic axis function during pregnancy. In this review, we show that pregnancy in women with acromegaly is generally safe, usually with tumoral and hormonal stability. Although the paucity of data limits evidence-based recommendations for preconception counseling and pregnancy surveillance, controlling tumor size and hormonal activity before pregnancy is highly recommended to ensure better outcomes, and surgical control should be attempted when feasible. Treatment interruption at pregnancy confirmation has also proven to be safe, as drugs are not formally allowed to be used during pregnancy. Drug exposure (somatostatin analogs) during early or whole pregnancy might increase the chance of a lower birth weight. Aggressive disease is uncommon and may urge individual decisions such as surgery or drug treatment during pregnancy or lactation.Correspondence should be addressed to J Abucham

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Section: Effect Of Pregnancy On Tumor Growth In Acromegalymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Acromegaly and pregnancy: a contemporary review

Abucham

Bronstein

Rodrigues

2017

European Journal of Endocrinology

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“…Clinical activity of acromegaly has been variably shown to improve (6,7), remain stable (8), or worsen during pregnancy (9), but no clear correlation with hormone levels has been established. Hormonal assessment of acromegaly during pregnancy is challenging.…”

Section: Introductionmentioning

confidence: 99%

Acromegaly and pregnancy: a prospective study

Rodrigues¹,

Boguszewski²,

Gadelha³

et al. 2014

European Journal of Endocrinology

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Context and objective: The interaction between pregnancy and acromegaly has been studied only retrospectively. We used prospective data to assess those interactions. Design: Prospective, interventional, multicentric study. Patients: Ten pregnancies in eight acromegalic patients were included according to the following criteria: previous diagnosis of acromegaly; and active acromegaly before pregnancy. Sellar magnetic resonance image (MRI), GH, and IGF1 measurements were carried out before pregnancy. The exclusion criterion was radiotherapy. Intervention: Withdrawal of pharmacological treatment (octreotide and/or cabergoline and/or pegvisomant) following pregnancy diagnosis. Main outcome measures: Clinical/biochemical evaluations throughout pregnancy/puerperium and sellar MRI after delivery; and GH and IGF1 measurements before pregnancy. GH was measured by an interference-free IFMA assay during pregnancy and IGF1 by measured by Immulite 2000 assay in patients and 64 control pregnancies. Results: No tumor growth was observed. Nine deliveries were at term and one at 35 weeks (preeclampsia). All newborns were healthy. Mean IGF1 levels before and during pregnancy were similar, but increased significantly during puerperium. As IGF1 in controls increased after midgestation, the prevalence of controlled IGF1 rose significantly from 2/10 (!20 weeks) to 9/10 (O30 weeks). Diabetes mellitus and hypertension/preeclampsia developed in one patient in each group; both complications were nonsignificantly (PZ0.06) associated with IGF1 O1.3 ULN before pregnancy. Conclusions: Acromegaly control usually improved and tumor growth was not stimulated during pregnancy in spite of withdrawal of drug treatment. Drug treatment can be discontinued in most patients. Uncontrolled disease before pregnancy may pose a higher risk for diabetes and hypertension.

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“…Apituitary and acephalic human fetuses in general have not shown appreciable deviations from the norm in length or weight at birth when these measurements are corrected for the cerebral defect (15)(16)(17)(18)52 (53). Similarly, infants born of mothers with active acromegaly have not been excessively large (10)(11)(12).…”

Section: Resultsmentioning

confidence: 99%

“…In man, the macrosomia observed in infants born to prediabetic or diabetic mothers has been attributed by some to an excess of maternal circulating growth hormone (4,(6)(7)(8)(9), thus implying transplacental passage of this growth-promoting substance and response of the fetal organism to exogenous hormone. Conversely, the normal birth weight of infants born to women with active acromegaly (10)(11)(12) and the relatively unimpaired growth of apituitary fetuses do not seem to support this hypothesis (13)(14)(15)(16)(17)(18).…”

mentioning

confidence: 99%