Acromegaly and pregnancy: a systematic review and meta-analysis

Bandeira, Diego Barata; Olivatti, Thainá Oliveira Felicio; Bolfi, Fernanda; Boguszewski, César Luiz; Nogueira, Vânia dos Santos Nunes

doi:10.1007/s11102-022-01208-0

Cited by 6 publications

(4 citation statements)

References 48 publications

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“…The rate of a more severe glucose profile in persons with pre-pregnancy DM or newly detected gestational DM was 9% and 6% for aggravated HBP and/or pre/eclampsia. The rate of premature labor was of 9%, spontaneous miscarriage 4%, small for gestational age 5% and 1% concerning congenital malformations [ 88 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tumor expansion might be found throughout pregnancy, particularly in macroadenomas that usually represent 90–95% of all somatotropinomas; we do not have enough evidence to conclude a clear rate of tumor growth during this period of time, varying from 0% to 9% [ 76 , 88 ]. Neurosurgery is feasible within the second trimester; most recently, selective pituitary resection has been less preferred during pregnancy, being restricted to uncontrolled cases under medical therapy which is associated with a larger body of evidence concerning its safety [ 27 , 38 , 78 ].…”

Section: Somatotropinoma Evolution During Gestationmentioning

confidence: 99%

“…Neurosurgery is feasible within the second trimester; most recently, selective pituitary resection has been less preferred during pregnancy, being restricted to uncontrolled cases under medical therapy which is associated with a larger body of evidence concerning its safety [ 27 , 38 , 78 ]. Particular clinical clues of tumor expansion are headache and visual field damage (which should be checked every 4–6 weeks in macroadenomas) [ 88 , 89 ]. Initially, somatrotropinoma increase might be approached via pharmacological intervention in most cases.…”

Section: Somatotropinoma Evolution During Gestationmentioning

confidence: 99%

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Approach of Acromegaly during Pregnancy

et al. 2022

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Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10–80%), and negative effects of glucose profile (GP) anomalies (10–70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5–15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7–50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT+ve and PT-ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.

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Section: Discussionmentioning

confidence: 99%

Section: Somatotropinoma Evolution During Gestationmentioning

confidence: 99%

Section: Somatotropinoma Evolution During Gestationmentioning

confidence: 99%

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Approach of Acromegaly during Pregnancy

et al. 2022

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“…Проведение оперативного лечения во время беременности безусловно повышает риск ее потери, так одна из трех вышеописанных беременностей закончилась выкидышем, две другихсвоевременными родами здоровых детей [20]. Тем не менее, обобщая описанные в литературе случаи вынашивания беременности у пациенток с акромегалией, можно сделать вывод, что в основном гестация не приводит к выраженному росту опухоли гипофиза или повышению риска развития внутриутробных аномалий плода [21], [22].…”

Section: Discussionunclassified

Successful pregnancy in a patient with acromegaly after somatostatin analogues and cabergoline treatment. therapy with somatostatin analogues and cabergoline

Knyazeva,

Vorotnikova,

Volevodz

et al. 2023

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The probability of pregnancy in women with acromegaly is relatively low, however modern therapy approaches make it possible to achieve disease compensation and improve reproductive function.World expert’s experience in managing pregnancy in patients with acromegaly is currently insufficient. Pregnancy may be associated with an increased risk for both mother and fetus due to the possible growth of the tumor, the development of metabolic complications (diabetes mellitus, arterial hypertension).This article describes a case of a successful pregnancy in a woman with active acromegaly occurring after somatostatin analogues and cabergoline treatment.

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Acromegaly and pregnancy: clinical management

Comune,

Cristilli,

Verrienti

et al. 2024

L'Endocrinologo

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SommarioL’acromegalia si associa frequentemente a ridotta fertilità nelle donne affette, complici più fattori tra cui l’età media alla diagnosi, l’iperprolattinemia, l’ipogonadismo ipogonadotropo e l’effetto diretto dell’eccesso di Growth Hormon/Insulin-like Growth Factor 1 (GH/IGF-1) sull’asse gonadotropo e sull’ovaio. Nonostante ciò, negli ultimi anni è in aumento il numero di gravidanze che si verificano in queste donne, grazie a una migliore efficacia dei trattamenti disponibili, permettendo il raggiungimento di un buon controllo di malattia, e grazie al ricorso a tecniche di riproduzione medicalmente assistita. Di conseguenza, aumenta anche la conoscenza riguardo ai rischi potenzialmente connessi a questa condizione. La gravidanza nelle donne acromegaliche ha generalmente un decorso privo di complicanze per madre e feto, tuttavia deve essere pianificata e gestita in maniera adeguata. In questa rassegna, in particolare, vengono esaminati gli effetti della gravidanza sulle dimensioni tumorali e sui livelli di GH e IGF-1, gli effetti dei farmaci GH soppressivi sul feto e l’impatto delle comorbilità cardiovascolari e metaboliche che si associano a malattia non controllata; viene inoltre proposto un modello di gestione alla luce delle evidenze in letteratura.

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Acromegaly and pregnancy: a systematic review and meta-analysis

Cited by 6 publications

References 48 publications

Approach of Acromegaly during Pregnancy

Approach of Acromegaly during Pregnancy

Successful pregnancy in a patient with acromegaly after somatostatin analogues and cabergoline treatment. therapy with somatostatin analogues and cabergoline

Acromegaly and pregnancy: clinical management

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