Outcome of pregnancies in a large cohort of women with acromegaly

Jallad, Raquel S.; Shimon, Ilan; Fraenkel, Merav; Medvedovsky, V.; Akirov, Amit; Duarte, Francisco Alberto de Moura; Bronstein, Marcello D.

doi:10.1111/cen.13599

Cited by 27 publications

(30 citation statements)

References 54 publications

(166 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Before the guidelines were published in 2014, there was no expert guidance for clinicians on the management of acromegaly during pregnancy, therefore clinical practice was based on available case series and available literature from prolactinomas. Reports that plasma IGF-1 concentrations fall during pregnancy suggest that withdrawal of medical therapy should not be detrimental to biochemical control of acromegaly during pregnancy (3,4).…”

Section: Introductionmentioning

confidence: 99%

“…There is limited data for outcomes of pregnancy in patients with acromegaly (3,4,7,8); the aim of this study, therefore, was to analyse the data generated from Irish patients with acromegaly who became pregnant and who were enrolled in the Irish Pituitary Study, in order to contribute to the body of knowledge regarding safety and outcomes of pregnancy in acromegalic patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

Hannon

O'Shea

Thompson

et al. 2019

European Journal of Endocrinology

View full text Add to dashboard Cite

Pregnancy is rarely reported in acromegaly. Many patients are diagnosed in later life and younger patients may have subfertility due to hypopituitarism. We present a case series of 17 pregnancies in 12 women with acromegaly. Twelve women with acromegaly who completed pregnancy were identified from centres involved in the Irish Pituitary Study. Eleven women had pituitary macroadenomas and one woman had a microadenoma. Only 5/17 pregnancies had optimal biochemical control of acromegaly preconception, as defined by IGF-1 concentration in the age-related reference level and plasma GH concentration of <2 μg/L. In 6/17 pregnancies, dopamine agonist treatment was continued during pregnancy; all other acromegaly treatments were discontinued during pregnancy. Effect of pregnancy on acromegaly: No patient developed new visual field abnormalities, or symptoms suggestive of tumour expansion during pregnancy. In 9/12 patients, plasma IGF-1 concentrations that were elevated preconception normalised during pregnancy. There was a reduction in plasma IGF-1 concentrations, though not into the normal range, in a further two pregnancies. Effect of acromegaly on pregnancy: 15 healthy babies were born at term; one patient underwent emergency C-section at 32 weeks for pre-eclampsia, and one twin pregnancy had an elective C-section at 35 weeks' gestation. Blood pressure remained within normal limits in the remainder of the pregnancies. Gestational diabetes did not develop in any pregnancy. Our data suggests that pregnancy in women with acromegaly is generally safe, from a maternal and foetal perspective. Furthermore, biochemical control tends to improve despite the withdrawal of somatostatin analogue therapy during pregnancy.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

Hannon

O'Shea

Thompson

et al. 2019

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Scientific insights into this crucial event in a woman’s life have recently been reported and pregnancy is generally considered safe [ 84 - 89 ]. Large tumors and/or those close to optic pathways should be resected by a skilled neurosurgeon in order to improve fertility and prevent pituitary enlargement (and possible apoplexy) during pregnancy.…”

Section: Clinical Issuesmentioning

confidence: 99%

Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues

Cozzi

Ambrosio

Attanasio

et al. 2020

EMIDDT

View full text Add to dashboard Cite

: Acromegaly is a rare disease. Improvements in lifespan in these patients have recently been reported due to transsphenoidal surgery (TSS), advances in medical therapy, and tighter criteria for defining disease remission. This document reports the opinions of a group of Italian experts who have gathered together their prolonged clinical experience in the diagnostic and therapeutic challenges of acromegaly patients. Both GH and IGF-I (only IGF-I in those treated with Pegvisomant - PegV) are needed in the diagnosis and follow-up. Comorbidities (cardio-cerebrovascular disease, sleep apnea, metabolic derangement, neoplasms, and bone/joint disease) should be specifically addressed. Any newly diagnosed patient should be referred to a multidisciplinary team experienced in the treatment of pituitary adenomas.

show abstract

“…Therapy with a dopamine agonist may be considered for patients with tumors which extend to the chiasm or show invasive growth. The most data on the use of drugs in pregnancy is available for somatostatin analogs and the dopamine agonists bromocriptine and cabergoline 26 ; continuation of therapy using somatostatin analogs during pregnancy has been described in case reports and small series 2 , 23 , 27 . There were no indications of teratogenicity or an increased rate of malformations.…”

Section: Reviewmentioning

confidence: 99%

“…eine dopaminagonistische Therapie erwogen werden. Die meiste Erfahrung zur Anwendung während der Schwangerschaft liegt für Somatostatin-Analoga und die Dopaminagonisten Bromocriptin und Cabergolin vor 26 ; in Fallberichten und kleinen Serien ist die Fortführung einer Therapie mit Somatostatin-Analoga während der Schwangerschaft beschrieben 2 , 23 , 27 . Hinweise auf Teratogenität oder eine erhöhte Rate an Missbildungen haben sich dabei nicht ergeben.…”

Section: Akromegalieunclassified

Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

Petersenn

Droste²,

Finke³

et al. 2019

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

The diagnosis and treatment of pituitary disease in pregnancy represents a special clinical challenge. Not least because there is very little data on the treatment of pregnant patients with pituitary disorders. A selective search of the literature was carried out with the aim of compiling evidence about the diagnosis and treatment of pituitary disease in pregnancy. The search covered the databases PubMed/MEDLINE including PubMed Central and also used the Livivo (ZB MED) search engine. Recent studies were evaluated for recommendations about the care of pregnant patients with hormone-inactive and hormone-active pituitary adenomas (prolactinoma, acromegaly and Cushingʼs disease), pituitary insufficiency, pituitary apoplexy and hypophysitis. The most well-established forms of treatment are for prolactinoma, due to the incidence of this disease and its impact on fertility. When pregnancy has been confirmed, prolactinoma treatment with dopamine agonists should be paused. Although microprolactinomas rarely increase significantly in size after the administration of dopamine agonists is discontinued, symptomatic tumor growth of macroprolactinomas can occur. In such cases, treatment with dopamine agonists can be resumed. If the primary tumor is large and the risk that it will continue to grow is high, it may be necessary to continue medical treatment from the start of pregnancy. If one of the partners has a pituitary disorder, it is often still possible for many couples to achieve their wish of having children if they receive medical support to plan and the pregnancy is carefully monitored. Given the complexity of pituitary disease, pregnant patients with pituitary disorders should be cared for and treated by a multidisciplinary team in centers specializing in the diagnosis and treatment of pituitary disease.

show abstract

Outcome of pregnancies in a large cohort of women with acromegaly

Abstract: Our study confirms the impact of gestation on IGF-1 levels. However, it also indicates that acromegaly still holds an increased risk for worsening of comorbidities, especially in uncontrolled patients.

Cited by 27 publications

References 54 publications

Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

Pregnancy in acromegaly is safe and is associated with improvements in IGF-1 concentrations

Italian Association of Clinical Endocrinologists (AME) and Italian AACE Chapter Position Statement for Clinical Practice: Acromegaly - Part 1: Diagnostic and Clinical Issues

Pituitary Disease in Pregnancy: Special Aspects of Diagnosis and Treatment?

Contact Info

Product

Resources

About