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

Abstract

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

Outcome of pregnancies in a large cohort of women with acromegaly

“…In many active patients with acromegaly, IGF‐1 levels normalized during pregnancy and subsequently increased following delivery or abortion. During normal pregnancy, the placental production of GH variant starts to increase at 10th weeks of gestation and reaches a plateau after the 30th week . Pituitary and placental GH influence serum IGF‐1, whose levels tend to increase and suppress GH levels .…”

“…The importance of pregnancy in acromegaly relates to the fact that its comorbidities (diabetes, hypertension, etc.) carry a significant risk to both the foetus and the mother, as compared to the gestation of healthy women . Additionally, complications related to pituitary tumour expansion can also occur .…”

“…Additionally, complications related to pituitary tumour expansion can also occur . Recently, articles addressing pregnancy in acromegaly have been published, but data are still limited and controversial …”

“…carry a significant risk to both the foetus and the mother, as compared to the gestation of healthy women. 10,12,[15][16][17][18][19][20][21][22][23][24] Additionally, complications related to pituitary tumour expansion can also occur. 9,10,12,15,25,26 Recently, articles addressing pregnancy in acromegaly have been published, but data are still limited and controversial.…”

“…9,10,12,15,25,26 Recently, articles addressing pregnancy in acromegaly have been published, but data are still limited and controversial. [18][19][20][21][22][23][24] This study was carried out to evaluate the maternal-neonatal outcomes of pregnancy in a large cohort of women with acromegaly, aiming to contribute to the management of this rare disease during gestation.…”