Pregnancy and acromegaly: a review

Abstract

To review the literature regarding the diagnosis and management of acromegaly during pregnancy. A systematic literature search was performed using MEDLINE including hand-searching reference lists from original articles. The diagnosis of acromegaly during pregnancy is made difficult due to the physiologic changes in pituitary GH secretion and IGF-1 production resulting from placental GH secretion and the inability of commercial assays to discriminate between pituitary and placental GH. Most patients with acromegaly during pregnancy do not have an increase in tumor size, metabolic complications are uncommon, and neonatal outcome is largely unaffected. IGF-1 levels tend to be stable in such patients possibly due to the high estrogen levels causing GH resistance. Dopamine agonists, somatostatin analogues, and a GH receptor antagonist have been reported to be safe during pregnancy. Patients with visual field defects should be considered for surgery, but in most cases this can be safely postponed until after delivery. Overall, pregnancy in acromegaly is uneventful and newborns unaffected. Dopamine agonists and somatostatin analogues have not been associated with major adverse effects to the fetus; however, more data are needed to validate their safety.

Acromegaly and pregnancy: a prospective study

“…As both acromegaly and pregnancy are associated with hypertension and diabetes, in uncontrolled acromegalic patients, pregnancy is reported to increase the prevalence of those comorbidities (2) and potentially complicate obstetrical/ fetal outcomes. In analogy to the effects of pregnancy on both tumoral (3) and nontumoral (4) lactotrophic cells, tumor enlargement and/or lactotrophic hyperplasia in acromegaly could also compress the optic chiasm and lead to visual impairment during pregnancy (5).…”

Acromegaly and Pregnancy: Five New Cases

“…If the tumor mass or the treatments do not destroy the gonadotropin lineage, the reproductive potential is preserved; however, fertility in patients with acromegaly is generally known to be impaired (7). Conceptions (spontaneous as well as induced) have been reported in less than 150 cases in the literature till date, achieved with and without treatment (4,5,7,8). GH and IGF-1 levels were not measured routinely in the patients in our study.…”

“…It has been reported that octreotide crosses placenta (21,22), and therefore, it may potentially affect the fetal outcome. Nevertheless, based on the lack of sufficient data on the safety of SAs during pregnancy, it is generally recommended to limit their usage during pregnancy in symptomatic patients (4). None of the five patients in our study were treated during pregnancy; while only two of them were receiving octreotide when they received the diagnosis of pregnancy, following which their medical treatment was discontinued.…”

“…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).…”

“…On the other hand, the reported data have revealed that GH-secreting tumors may enlarge symptomatically during pregnancy (3). In addition, GH and IGF-1 levels change controversially during the pregnancy; however, in the majority of the cases, tumor growth is not observed (3)(4)(5)(6). Certain metabolic effects of acromegaly, such as diabetes mellitus and hypertension due to the elevated levels of GH and IGF-1, need to be considered as they can be harmful to both mother and fetus.…”