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

Abstract

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.

Bromocriptine therapy: Review of mechanism of action, safety and tolerability

“…However, macroprolactinomas (>10 mm diameter) require prolonged bromocriptine treatment or even transsphenoidal surgery along with bromocriptine therapy 52 . Many reports (~6000 reports) suggest the continuation of bromocriptine therapy even during pregnancy, 53,54 because in many cases hyperprolactinemia as well as prolactinoma enlargement has been reported after termination of bromocriptine therapy 55 . Moreover, previous studies reported that bromocriptine use in pregnancy does not increase the number of adverse pregnancies or neonatal outcomes, miscarriage or even congenital malformations, as compared to that of general population 56,57 .…”