Subcutaneous Implantable Defibrillator in an acromegalic pregnant woman for secondary prevention of sudden cardiac death: When (2) technologies save (2) lives

Viani, Stefano; Zucchelli, Giulio; Paperini, Luca; Soldati, Ezio; Cori, Andrea Di; Menichetti, Francesca; Coluccia, Giovanni; Andreini, D.; Branchitta, G; Bongiorni, Maria Grazia

doi:10.1016/j.ijcard.2016.08.249

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…The original data published within the last decade are observational studies underlying small (mostly) cohorts of acromegalic females or even single cases or pregnancies in patients with different types of pituitary tumors, somatotropinoma being one of them. The studied subgroups were formed either between individuals with controlled disease (under pharmaco-therapy) or suboptimal treated acromegaly; either between subjects who were further exposed to targeted therapy for GH excess or who respected the general recommendations to resume the medication at the moment of conception or pregnancy confirmation; or between first-trimester exposure to SSAs versus longer; and also in patients with GH excess recognition before gestation or during pregnancy; with pre-conception neurosurgery for pituitary adenoma or not [ 39 , 51 , 75 , 76 , 77 , 78 , 93 , 94 , 95 , 96 , 97 , 102 , 109 , 111 , 118 , 119 , 120 , 122 , 124 , 125 , 127 , 128 , 129 , 131 ] ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…As far as we currently know, despite a low level of statistical evidence, but with a growing number of publications lately, pregnancy seems safe regarding materno-fetal outcomes in most of the reported cases/studies. However, close multidisciplinary surveillance is required, as well as preconception counselling [ 75 , 122 , 123 , 124 ].…”

Section: Pregnancy Outcome and Materno-fetal Complicationsmentioning

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: Pregnancy Outcome and Materno-fetal Complicationsmentioning

confidence: 99%

Approach of Acromegaly during Pregnancy

et al. 2022

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“…To date, 1 other reported case of S-ICD implantation in pregnancy was described by Viani et al. ( 6 ). Some studies have shown that atrial pacing may be beneficial in preventing polymorphic ventricular tachycardia in LQTS ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Successful Subcutaneous Defibrillator Implantation in a Pregnant Patient With Long QT Syndrome

Myadam

Gupta

2021

JACC: Case Reports

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A 26-year-old woman with recurrent unexplained syncope in the postpartum period was diagnosed with long QT syndrome type 2. Traditional implantation of defibrillator using fluoroscopy became contraindicated after she again became pregnant prior to device implantation. A subcutaneous defibrillator was successfully implanted in the second trimester, after a multidisciplinary evaluation. ( Level of Difficulty: Intermediate. )

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Acromegaly and ultrasound: how, when and why?

Parolin

Dassiè

Vettor

et al. 2019

J Endocrinol Invest

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Background Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. Purpose This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. Conclusions Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

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Subcutaneous Implantable Defibrillator in an acromegalic pregnant woman for secondary prevention of sudden cardiac death: When (2) technologies save (2) lives

Cited by 5 publications

References 10 publications

Approach of Acromegaly during Pregnancy

Approach of Acromegaly during Pregnancy

Successful Subcutaneous Defibrillator Implantation in a Pregnant Patient With Long QT Syndrome

Acromegaly and ultrasound: how, when and why?

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