Pregnancy in acromegaly

Abstract

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.

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

“…Females suffering from acromegaly show lower IGF-1 levels than males who suffer from the same condition. It is interesting to highlight that in some specific acromegalic females, IGF-1 levels decrease during the first trimester of pregnancy [ 85 ]. A possible explanation could be the physiological increase in estrogen levels and their subsequent inhibition of IGF-1 production in the liver [ 84 ].…”

Clinical Features and Surgical Management of Pituitary Adenoma During Pregnancy: Case Series and Literature Review

“…During pregnancy, physicians may face many challenges when diagnosing and treating PAs. Although conservative treatment is recommended for some pregnant patients with PAs, such as prolactinoma, some patients may accept surgery due to visual defects, severe headaches, and high hormone secretion levels which cannot be alleviated after conservative treatment [7,[11][12][13][14]. We summarized the data of 41 patients with PAs who underwent surgery during pregnancy.…”

“…Conservative treatment during pregnancy mainly includes treatment of PAs and supplementation to hormone de ciency. DAs have been recommended for prolactinomas [1], and GH secreting PAs may be treated with SSAs [1,7]. Although there is no evidence that SSAs increase the risk of fetal malformation [6, [40][41][42], discontinuation of all medication except DAs during pregnancy is recommended to ensure fetal health to the maximum extent possible [7,8,43].…”

“…For example, patients with prolactinomas can orally take dopamine agonists (DAs) [1,[4][5][6]. Although there is no evidence that somatostatin analogue (SSA) is safe for the fetus during pregnancy, SSA is effective in reducing tumor size, growth hormone (GH) and insulin-like growth factor 1 (IGF1) levels in acromegaly [7,8]. However, some pregnant patients with acute compression Enumeration data were expressed as percentages or ratios.…”

Functioning Endocrine Tumors in Pregnancy: Diagnostic and Therapeutic Challenges

“…However, with successful medical and surgical treatment of the adenoma, and with advances in in vitro fertilization techniques, pregnancy rates in women with acromegaly have increased. [ 10 ] During the first trimester, because of estrogen-mediated hepatic resistance to GH, there is a fall in serum levels of IGF1 and a transient improvement in symptoms of acromegaly. However, with the progression of pregnancy, there is increased placental production of GH-Variant (GH-V) and IGF-1 levels increase by two-three fold.…”