Normal Delivery Following an Uneventful Pregnancy in a Japanese Acromegalic Patient after Discontinuation of Octreotide Long Acting Release Formulation at an Early Phase of Pregnancy

Tajiri, Tatsuro; Saito, Jun; Soyama, Akiko; Itô, Hiroko; Iizuka, Takashi; Yoshida, Takao; Nishikawa, Tetsuo

doi:10.1507/endocrj.53.209

Cited by 26 publications

(25 citation statements)

References 22 publications

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“…GH levels were stable but IGF-1 levels were significantly elevated after delivery. Similar cases of suppressed GH and/or IGF-1 during pregnancy have recently been reported by other investigators [5][6][7][8][9], and some patients showed clinical and biochemical improvement during pregnancy [8]. These data suggest that GH secretion in pregnant acromegalic patients may not be entirely autonomous and may be associated with a degree of negative feedback control that could be exerted by a circulating factor of placental origin, probably human placental lactogen or placental GH variant.…”

Section: Discussionsupporting

confidence: 84%

Suppressed levels of growth hormone and insulin-like growth factor-1 during successful pregnancy in persistent acromegaly

et al. 2010

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Pregnancy is a rather rare event in acromegalic women because fertility is often reduced during active disease [1,2]. Previous reports of pregnancy in acromegalic patients [3,4] showed that pituitary growth hormone (GH) levels were unaffected and the levels of serum insulin-like growth factor (IGF)-1 were elevated by increased placental GH variant during the second and third trimesters. We report here a case of persistent acromegaly that showed suppressed levels of GH and IGF-1 during pregnancy. case reportThe patient had demonstrated amenorrhea, body weight gain and progressive enlargement of the hands and feet since the age of 31 after a normal pregnancy and delivery. At the age of 36, she was examined for suspected acromegaly. Mean basal GH levels were 44.7ng/ mL, which decreased to 28.8ng/mL during an oral gluSuppressed levels of growth hormone and insulin-like growth factor-1 during successful pregnancy in persistent acromegaly abstract. Pregnancy is a rather rare event in acromegaly because fertility is often reduced during active disease. Previous reports of pregnancy in acromegalic patients showed that the pituitary growth hormone (GH) level was unaffected and the insulin-like growth factor (IGF)-1 level was elevated during the second and third trimesters. We describe here a case of persistent acromegaly that showed suppressed levels of GH and IGF-1 during pregnancy. The suppression of GH secretion and IGF-1 may be due to increased estrogen or other factors circulating in mid-to late pregnancy.Key words: Acromegaly, Pregnancy, IGF-1, Octreotide, Radiosurgery cose tolerance test with elevated IGF-1 levels (1515ng/ mL). Pituitary magnetic resonance imaging (MRI) showed an adenoma measuring 20 mm in diameter invading the right cavernous sinus. The patient underwent adenomectomy by the transsphenoidal approach, but basal GH levels remained elevated (17.1ng/mL) after surgery. She received 300 µg octreotide acetate subcutaneously (s.c.) daily, and stereotactic radiosurgery was performed with a marginal dose of 18Gy to the residual adenoma in the right cavernous sinus. Basal levels of GH and IGF-1 decreased to 8.5ng/mL and 753ng/mL, respectively, and ovulatory menstrual cycles resumed. Eleven months later, octreotide was discontinued because of pregnancy, and at 5 weeks of pregnancy, GH was 17.3ng/mL and IGF-1 1100ng/mL. At 10, 21 and 33 weeks of pregnancy, GH and IGF-1 levels were both suppressed to 9.9, 5.5 and 5.9ng/mL, and 878, 291 and 446ng/mL, respectively. Normal vaginal delivery took place at 43 weeks. Postpartum GH levels were 5.0 and 7.0ng/mL; IGF-1 levels increased to 640 and 782ng/mL 3 and 9 weeks after delivery. Repeated MRI after delivery showed moderate shrinkage of the residual adenoma. Serum GH concentrations were determined by immunoradiometric assay (IRMA; GH Kit "Daiichi", TFB Inc., Tokyo) and did not cross-react with the placental GH variant. Plasma IGF-1 concentrations were also determined by IRMA (IGF-1 IRMA "Daiichi",

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Section: Discussionsupporting

confidence: 84%

Suppressed levels of growth hormone and insulin-like growth factor-1 during successful pregnancy in persistent acromegaly

et al. 2010

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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%

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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“…Although SA, octreotide, and lanreotide are more efficacious than DA for the treatment of acromegaly, these agents have not been commonly used during pregnancy (4). Uneventful pregnancies have been reported in which SA was continued during the pregnancy without any side effects (13,20,21). Besides, medical treatment with SA during pregnancy was associated with low birth weight.…”

Section: Discussionmentioning

confidence: 99%

Acromegaly and Pregnancy: Five New Cases

Önder¹,

Aydın²,

Soysal³

et al. 2017

Turk J Endocrinol Metab

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Normal Delivery Following an Uneventful Pregnancy in a Japanese Acromegalic Patient after Discontinuation of Octreotide Long Acting Release Formulation at an Early Phase of Pregnancy

Cited by 26 publications

References 22 publications

Suppressed levels of growth hormone and insulin-like growth factor-1 during successful pregnancy in persistent acromegaly

Suppressed levels of growth hormone and insulin-like growth factor-1 during successful pregnancy in persistent acromegaly

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

Acromegaly and Pregnancy: Five New Cases

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