Pregnancy and acromegaly

Muhammad, Ammar; Neggers, Sebastian J C M M; Lely, Aart-Jan van der

doi:10.1007/s11102-016-0740-3

Cited by 31 publications

(21 citation statements)

References 37 publications

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“…24 – 26 In pregnancy, homology between GH and placental GH makes GH measurement especially challenging in acromegaly cases. 27 Chronic renal failure can lead to higher GH but IGF-1 remains unchanged or can even decrease. 28 Type 2 diabetes and insulin resistance are associated with higher GH due to impaired suppression by glucose, while chronic hyperglycaemia has shown to be associated with decreased GH release.…”

Section: Screening and Diagnosismentioning

confidence: 99%

Updates in Diagnosis and Treatment of Acromegaly

Zahr

Fleseriu

2018

European Endocrinology

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Acromegaly is a rare disease, caused largely by a growth hormone (GH) pituitary adenoma. Incidence is higher than previously thought. Due to increased morbidity and mortality, if not appropriately treated, early diagnosis efforts are essential. Screening is recommended for all patients with clinical features of GH excess. There is increased knowledge that classical diagnostic criteria no longer apply to all, and some patients can have GH excess with normal GH response to glucose. Treatment is multifactorial and personalised therapy is advised.

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Section: Screening and Diagnosismentioning

confidence: 99%

Updates in Diagnosis and Treatment of Acromegaly

Zahr

Fleseriu

2018

European Endocrinology

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“…Other causes, for example a tumor secreting GH-releasing hormone (GHRH), are very rare 22 . 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 .…”

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%

“…The pituitary gland increases in volume due to hyperplasia of the prolactin cells and changes in pituitary hormone secretions 1 . Prolactin levels rise throughout the entire pregnancy, with the placenta also taking over the synthesis of growth hormone (GH) and suppressing pituitary GH 2 . GH levels continue to rise until the 36th/37th week of pregnancy, achieving levels which are many times higher than before the start of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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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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“…Current available data regarding pregnant women with acromegaly are limited, mostly composed of case reports, series of cases, and a few retrospective studies. 1,2 The hormonal balance of the somatotropic axis during physiological pregnancy follows a dynamic course, which is characterized by a gradual decrease of pituitary GH (native GH, GH-N), followed in the last two trimesters by rising levels of placental GH (variant GH, GH-V). Both GH-V and IGF-1 reach a peak around the last weeks of pregnancy, the latter being at least two times higher on average than before pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Successful Pregnancy in a Patient with Long-Standing Acromegaly – a Case Report

Gliga¹,

Pașcanu

Gliga

et al. 2020

Journal of Interdisciplinary Medicine

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Introduction: Acromegaly is a rare endocrine disorder of the growth hormone (GH)-insulin-like growth factor 1 (IGF1) metabolism that can affect women of fertile age. Although uncommon, pregnancies in acromegalic women can occur, with data regarding the management of these cases being very limited, mostly consisting of case reports.Case Presentation: We present the case of an acromegalic woman, first diagnosed at the age of 22, after the surgical resection of a pituitary mass. Throughout the evolution, she received conventional radiotherapy and has been treated with somatostatin receptor ligands (SRLs), dopamine agonists (DAs), and GH-blockers. At the age of 37, the patient decided to become pregnant while she was on Pegvisomant and DA therapy. The treatment was stopped, and the patient became pregnant at the age of 38. Tumor size and IGF-1 values have remained stable throughout the pregnancy, and no complications occurred. A healthy child with normal birth weight was delivered on term through Cesarean section.Conclusions: Managing pregnant women with acromegaly is challenging because of the little available data regarding the safety of medical treatment and a high interindividual variability of GH-IGF-1 evolution during this period. The particularity of our case was a patient with a long history of acromegaly, who had an uneventful pregnancy despite stopping all medical treatment.

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Pregnancy and acromegaly

Cited by 31 publications

References 37 publications

Updates in Diagnosis and Treatment of Acromegaly

Updates in Diagnosis and Treatment of Acromegaly

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

Successful Pregnancy in a Patient with Long-Standing Acromegaly – a Case Report

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