Acromegaly and Pregnancy: A Retrospective Multicenter Study of 59 Pregnancies in 46 Women

Abstract

The following conclusions were reached: 1) pregnancy in women with active or uncontrolled acromegaly may be associated with an increased risk of gestational diabetes and gravid hypertension; 2) pregnancy is occasionally associated with symptomatic enlargement of GH-secreting pituitary macroadenomas; 3) changes in serum GH and IGF-I concentrations are variable during pregnancy, indicating that routine monitoring is not mandatory if the pregnancy is uneventful; and 4) GH-suppressive treatment can be safely withdrawn after conception in most acromegalic women.

Acromegaly and Pregnancy: Five New Cases

“…It has been presumed that this improvement in the IGF-1 levels could be due to the effect of the marked increase in the estrogen levels during pregnancy (12). However, the impact of pregnancy on the GH and IGF-1 levels in acromegalic patients is limited to sporadic cases (3,7,13,14). Therefore, monitoring of GH and IGF-1 levels in the pregnant acromegalic patients is not necessary.…”

“…A major concern during pregnancy in acromegalics is the tumor growth. Although theoretically, adenoma enlargement may be expected in the acromegalic patients because of the estrogen exposure (3), in the majority of the patients, tumor enlargement is not observed (4,5,7,13,15). In a normal pregnancy, this has little clinical significance; however, in patients with residual tumor or unresected tumors, an increase in the gland size can cause visual field defects, headaches, and potentially, pituitary apoplexy (16)(17)(18).…”

“…Although SA, octreotide, and lanreotide are more efficacious than DA for the treatment of acromegaly, these agents have not been commonly used during pregnancy (4). Uneventful pregnancies have been reported in which SA was continued during the pregnancy without any side effects (13,20,21). Besides, medical treatment with SA during pregnancy was associated with low birth weight.…”

“…Another important concern during pregnancy in patients with acromegaly is the effect of excess GH/IGF-1 levels on the mother and the fetus. Further, theoretically, women with acromegaly are at a higher risk for glucose intolerance or hyperglycemia as the pregnancy itself is an insulin-resistant state (13). Despite the limited data, the follow-up to check for the occurrence of gestational diabetes, coronary artery disease, hypertension, and dyslipidemia is strongly recommended (16,23,24).…”

“…Acromegaly can potentially affect the fetus; however, there are limited data supporting this, as most of the studies have reported normal, healthy infants. (3,7,13). It is known that the disease can be associated with miscarriage, premature births, abnormal birth weight, and growth retardation (21).…”