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

Abstract

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.

Gestational diabetes and acromegaly: Single‐centre experience of 14 pregnancies

“…In the French study, including 59 pregnancies, reported frequency of GD was 9% when IGF‐1 level was noncontrolled in preconception versus 6.4% when IGF‐1 secretion was controlled. This excess of GD is not observed in the Irish study: despite a high number of noncontrolled patients in terms of GH/IGF‐1 hypersecretion before pregnancy (12 out of 17 pregnancies, 70.6%), none developed GD . In our study, among women monitored for GD, 57% were not controlled before pregnancy (versus 29% among women without GD).…”

“…More than 150 pregnancies in women with acromegaly have been reported in the literature . So far, the prevalence of GD seems very low during pregnancies in acromegalic women, with only 5 cases of GD in 147 pregnancies .…”

“…So far, the prevalence of GD seems very low during pregnancies in acromegalic women, with only 5 cases of GD in 147 pregnancies . For example, in a study recently published, no GD was reported in 17 women with acromegaly . In these studies (with many missing data), acromegalic women were on average 31 years old, GH/IGF‐1 hypersecretion was associated with pituitary macroadenoma, 75% underwent pituitary surgery before conception, few had radiotherapy, and 50% of them had a medical treatment by somatostatin analogues and dopamine agonists.…”

“…Indeed, in most case reports or in small series of pregnancies reported in the literature, it is not clear whether GD was systematically screened, and if so, what screening method was used. An OGTT screening during the 2nd trimester was performed in women reported by Hannon et al In our cohort, all women were screened for GD, either by fasting blood glucose during 1st or 2nd trimesters or by an oral glucose tolerance test later in gestation. Five GD were detected with fasting blood glucose (≥0.92 g/L) and 2 with 75 g OGTT in the 3rd trimester of pregnancy.…”

“…Pregnancy itself induces insulin resistance, and women with acromegaly should thus be more prone to develop gestational diabetes (GD). Review of the literature reveals rare cases of GD associated with acromegaly: only 5 GD in 147 pregnancies (Table ). However, most publications do not mention whether GD was systematically screened, and if so, what screening method was used.…”