Effects of octreotide exposure during pregnancy in acromegaly

Maffei, Pietro; Tamagno, Gianluca; Nardelli, Giovanni Battista; Videau, Catherine; Menegazzo, Carla; Milan, Gabriella; Calcagno, Alessandra; Martini, Chiara; Vettor, Roberto; Epelbaum, Jacques; Sicolo, Nicola

doi:10.1111/j.1365-2265.2009.03706.x

Cited by 76 publications

(44 citation statements)

References 36 publications

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“…Newborns from women who interrupted medical treatment before or at the beginning of pregnancy have been typically normal (2,3,4,5,38). Also, children born from women with acromegaly who discontinued treatment during pregnancy have been shown to have normal general health status at 2, 3 and 6 years of age (73,74,75), as well as IQ scores similar to those born from normal women or from women with prolactinoma (76). However, as some patients with acromegaly may have or develop impaired glucose tolerance/diabetes mellitus and hypertension during pregnancy, their newborns should also be considered at a higher risk for macrosomia and microsomia (77) respectively.…”

Section: Effect Of Acromegaly and Its Treatment On Fetal Developmentmentioning

confidence: 99%

“…Although octreotide crosses placental barrier and placenta has somatostatin receptors that bind octreotide (78), no serious adverse fetal outcomes have been detected in nearly 50 (2,3,4,5,7,36,38,47,48,50,51,55,57,63,79,80,81,82,83,84) cases of transient exposure (mostly in first trimester) nor in a much smaller number of continuous exposure to somatostatin analogs (SA) and/or dopaminergic agonists (4,64,73,75,78,85,86,87). Notwithstanding, concerns about low birth weight associated to fetal exposure to SA either alone or, as more often reported, in combination with dopaminergic agonists (DA) have been raised by a large retrospective study and by few case reports (3,4,85,88).…”

Section: Effect Of Acromegaly and Its Treatment On Fetal Developmentmentioning

confidence: 99%

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

Abucham

Bronstein

Rodrigues

2017

European Journal of Endocrinology

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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

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Section: Effect Of Acromegaly and Its Treatment On Fetal Developmentmentioning

confidence: 99%

Section: Effect Of Acromegaly and Its Treatment On Fetal Developmentmentioning

confidence: 99%

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

Abucham

Bronstein

Rodrigues

2017

European Journal of Endocrinology

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“…Octreotide crosses the placental barrier, is present in maternal milk, and has been shown to decrease fetal size (14). Cabergoline, on the other hand, is considered safe during pregnancy (15), but impairs lactation.…”

Section: Obstetrical/fetal Outcomes and Lactationmentioning

confidence: 99%

“…With the widespread use of pharmacological treatment to control disease activity, a consensus on acromegaly management has recently stated the need to encourage reporting of outcomes in medically treated pregnant patients (13). During pregnancy, pharmacological treatment with somatostatin analogs has been associated with decreased length in newborns (14), whereas cabergoline has been considered probably safe in prolactinomas (15), and pegvisomant, a GH receptor antagonist, has been reportedly used in only two cases (16,17). Although cessation of medical therapy during pregnancy has been usually advised (13), this recommendation results primarily from the lack of a large database on drug safety and not from prospective studies on pregnancy outcomes following drug withdrawal.…”

Section: Introductionmentioning

confidence: 99%

Acromegaly and pregnancy: a prospective study

Rodrigues¹,

Boguszewski²,

Gadelha³

et al. 2014

European Journal of Endocrinology

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Context and objective: The interaction between pregnancy and acromegaly has been studied only retrospectively. We used prospective data to assess those interactions. Design: Prospective, interventional, multicentric study. Patients: Ten pregnancies in eight acromegalic patients were included according to the following criteria: previous diagnosis of acromegaly; and active acromegaly before pregnancy. Sellar magnetic resonance image (MRI), GH, and IGF1 measurements were carried out before pregnancy. The exclusion criterion was radiotherapy. Intervention: Withdrawal of pharmacological treatment (octreotide and/or cabergoline and/or pegvisomant) following pregnancy diagnosis. Main outcome measures: Clinical/biochemical evaluations throughout pregnancy/puerperium and sellar MRI after delivery; and GH and IGF1 measurements before pregnancy. GH was measured by an interference-free IFMA assay during pregnancy and IGF1 by measured by Immulite 2000 assay in patients and 64 control pregnancies. Results: No tumor growth was observed. Nine deliveries were at term and one at 35 weeks (preeclampsia). All newborns were healthy. Mean IGF1 levels before and during pregnancy were similar, but increased significantly during puerperium. As IGF1 in controls increased after midgestation, the prevalence of controlled IGF1 rose significantly from 2/10 (!20 weeks) to 9/10 (O30 weeks). Diabetes mellitus and hypertension/preeclampsia developed in one patient in each group; both complications were nonsignificantly (PZ0.06) associated with IGF1 O1.3 ULN before pregnancy. Conclusions: Acromegaly control usually improved and tumor growth was not stimulated during pregnancy in spite of withdrawal of drug treatment. Drug treatment can be discontinued in most patients. Uncontrolled disease before pregnancy may pose a higher risk for diabetes and hypertension.

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“…Besides, medical treatment with SA during pregnancy was associated with low birth weight. 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).…”

Section: Discussionmentioning

confidence: 99%