Spontaneous Conception and Term Delivery in a Woman with Ucontrolled Acromegaly and Hypogonadotropic Hypogonadism

Căpăþînă, C; Radian, Șerban; Baciu, Ionela; Ghinea, Adela; Deciu, Diana; Dumitrașcu, Anda; Ciubotaru, Vasile; Poiană, Cătălina

doi:10.4183/aeb.2016.481

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…In our cohort, the majority of pregnancies arose spontaneously. Although acromegaly is widely discussed to be associated with infertility, spontaneous pregnancy is possible [ 12 ]. In discussing our results, it is important to note that of the pregnancies studied, pituitary insufficiency was diagnosed only in three patients before pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of patients acromegaly is associated with hypogonadotropic hypogonadism resulting in a decreased fertility [ 12 , 13 ]. Nevertheless, previous studies could reveal that therapeutic disease control could result in a recovery of pituitary function and an improvement of fertility [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, previous studies could reveal that therapeutic disease control could result in a recovery of pituitary function and an improvement of fertility [ 14 ]. However, spontaneous pregnancy in acromegalic patients with active disease has also been described [ 12 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy and acromegaly: clinical outcomes of retrospectively analysed data from the German acromegaly registry

Tönjes,

Würfel,

Quinkler

et al. 2024

Reprod Biol Endocrinol

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Context Acromegaly is a rare disease caused by excessive growth hormone (GH) secretion, mostly induced by pituitary adenomas. The care of pregnant women with acromegaly is challenging, in part due to existing clinical data being limited and not entirely consistent with regard to potential risks for mother and child. Objective To retrospectively examine data on pregnancy and maternal as well as neonatal outcomes in patients with acromegaly. Design & methods Retrospective data analysis from 47 pregnancies of 31 women treated in centers of the German Acromegaly Registry. Results 87.1% of the studied women underwent transsphenoidal surgery before pregnancy. In 51.1% a combination of dopamine agonists and somatostatin analogs were used before pregnancy. Three women did not receive any therapy for acromegaly. During pregnancy only 6.4% received either somatostatin analogs or dopamine agonists. In total, 70.2% of all documented pregnancies emerged spontaneously. Gestational diabetes was diagnosed in 10.6% and gravid hypertension in 6.4%. Overall, no preterm birth was detected. Indeed, 87% of acromegalic women experienced a delivery without complications. Conclusion Pregnancies in women with acromegaly are possible and the course of pregnancy is in general safe for mother and child both with and without specific treatment for acromegaly. The prevalence of concomitant metabolic diseases such as gestational diabetes is comparable to the prevalence in healthy pregnant women. Nevertheless, larger studies with more data in pregnant patients with acromegaly are needed to provide safe and effective care for pregnant women with this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pregnancy and acromegaly: clinical outcomes of retrospectively analysed data from the German acromegaly registry

Tönjes,

Würfel,

Quinkler

et al. 2024

Reprod Biol Endocrinol

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Approach of Acromegaly during Pregnancy

et al. 2022

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Acromegaly-related sub/infertility, tidily related to suboptimal disease control (1/2 of cases), correlates with hyperprolactinemia (1/3 of patients), hypogonadotropic hypogonadism—mostly affecting the pituitary axis in hypopituitarism (10–80%), and negative effects of glucose profile (GP) anomalies (10–70%); thus, pregnancy is an exceptional event. Placental GH (Growth Hormone) increases from weeks 5–15 with a peak at week 37, stimulating liver IGF1 and inhibiting pituitary GH secreted by normal hypophysis, not by somatotropinoma. However, estrogens induce a GH resistance status, protecting the fetus form GH excess; thus a full-term, healthy pregnancy may be possible. This is a narrative review of acromegaly that approaches cardio-metabolic features (CMFs), somatotropinoma expansion (STE), management adjustment (MNA) and maternal-fetal outcomes (MFOs) during pregnancy. Based on our method (original, in extenso, English—published articles on PubMed, between January 2012 and September 2022), we identified 24 original papers—13 studies (3 to 141 acromegalic pregnancies per study), and 11 single cases reports (a total of 344 pregnancies and an additional prior unpublished report). With respect to maternal acromegaly, pregnancies are spontaneous or due to therapy for infertility (clomiphene, gonadotropins or GnRH) and, lately, assisted reproduction techniques (ARTs); there are no consistent data on pregnancies with paternal acromegaly. CMFs are the most important complications (7.7–50%), especially concerning worsening of HBP (including pre/eclampsia) and GP anomalies, including gestational diabetes mellitus (DM); the best predictor is the level of disease control at conception (IGF1), and, probably, family history of 2DM, and body mass index. STE occurs rarely (a rate of 0 to 9%); some of it symptoms are headache and visual field anomalies; it is treated with somatostatin analogues (SSAs) or alternatively dopamine agonists (DAs); lately, second trimester selective hypophysectomy has been used less, since pharmaco-therapy (PT) has proven safe. MNA: PT that, theoretically, needs to be stopped before conception—continued if there was STE or an inoperable tumor (no clear period of exposure, preferably, only first trimester). Most data are on octreotide > lanreotide, followed by DAs and pegvisomant, and there are none on pasireotide. Further follow-up is required: a prompt postpartum re-assessment of the mother’s disease; we only have a few data confirming the safety of SSAs during lactation and long-term normal growth and developmental of the newborn (a maximum of 15 years). MFO seem similar between PT+ve and PT-ve, regardless of PT duration; the additional risk is actually due to CMF. One study showed a 2-year median between hypophysectomy and pregnancy. Conclusion: Close surveillance of disease burden is required, particularly, concerning CMF; a personalized approach is useful; the level of statistical evidence is expected to expand due to recent progress in MNA and ART.

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Spontaneous Conception and Term Delivery in a Woman with Ucontrolled Acromegaly and Hypogonadotropic Hypogonadism

Cited by 2 publications

References 26 publications

Pregnancy and acromegaly: clinical outcomes of retrospectively analysed data from the German acromegaly registry

Pregnancy and acromegaly: clinical outcomes of retrospectively analysed data from the German acromegaly registry

Approach of Acromegaly during Pregnancy

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