Medical treatment of acromegaly in pregnancy, highlights on new reports

Fleseriu, Maria

doi:10.1007/s12020-015-0603-0

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…The majority of patients discontinued pegvisomant upon confirmation of pregnancy apart from three patients who continued it throughout pregnancy. A minimal transplacental passage of the drug has been documented and drug has not been detected in breast milk [Brian et al 2007;Fleseriu, 2015]. Babies born were reported to be normal and continued to be for up to 6 months of follow up [V Cheng et al 2012].…”

Section: Effect Of Drug Exposure During Pregnancymentioning

confidence: 99%

Pregnancy in acromegaly

Laway

2015

Therapeutic Advances in Endocrinology

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With advances in surgical and medical treatment and the availability of assisted reproductive techniques, pregnancy in women with acromegaly is more frequently encountered. Diagnosis of acromegaly during pregnancy is difficult because of changes in growth hormone and insulin like growth factor-1 (IGF-1) axis secondary to placental production of growth hormone. The difficulty is compounded by the inability of routine hormone assays to detect placental growth hormone. In the majority of patients with acromegaly, pregnancy does not have an adverse effect on mother or fetus and pituitary mass does not increase in size. The level of IGF-1 usually remains stable because of the effect of estrogen causing a growth hormone resistant state. In patients with pituitary macroadenoma, the possibility of an increase in size of the pituitary mass needs to be kept in mind and more frequent monitoring is required. In case of tumor enlargement, pituitary surgery can be considered in the mid trimester. Experience with the use of medical treatment for acromegaly during pregnancy is increasing. Dopamine agonists, somatostatin analogs or growth hormone receptor antagonists have been used without any adverse consequences on mother or fetus. At present, it is advisable to stop any medical treatment after confirmation of pregnancy till more data are available on the safety of these drugs.

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Section: Effect Of Drug Exposure During Pregnancymentioning

confidence: 99%

Pregnancy in acromegaly

Laway

2015

Therapeutic Advances in Endocrinology

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“…GH and the target hormone IGF-1 which is synthesized in the liver do no cross the placental barrier 2 , meaning that the infant is not affected by maternal acromegaly. According to retrospective case studies, active acromegaly in pregnancy is associated with a risk of the patient developing gestational diabetes and hypertension 23 , 24 . Somatotropic adenomas do not usually increase in size during pregnancy, with the possible exception of increased growth due to a “rebound” phenomenon after discontinuing therapy with somatostatin analogs.…”

Section: Reviewmentioning

confidence: 99%

“…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%

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

Petersenn

Droste²,

Finke³

et al. 2019

Geburtshilfe Frauenheilkd

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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.

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“…GH does not cross the placenta, and maternal acromegaly has little direct impact on the fetus. While initial reports suggested fetus growth retardation due to hemodynamic changes in materno-fetal barrier, further studies failed to confirm an association with small babies for gestational age and suggested no apparent adverse effects [8,20,23].…”

Section: Effect Of Acromegaly On Fetusmentioning

confidence: 99%

“…Treatments currently available for acromegaly include surgery, drug treatment and, in some cases, radiotherapy. These therapeutic modalities achieve tumor growth control and minimize the clinical consequences of hypersomatotropism in most patients [8]. Despite the positive impact of current treatments on survival and quality of life, pregnancy in acromegaly continues to be an uncommon event and a challenge for clinicians.…”

Section: Introductionmentioning

confidence: 99%