Uneventful octreotide LAR therapy throughout three pregnancies, with favorable delivery and anthropometric measures for each newborn: a case report

Abstract

IntroductionThe safety of octreotide use, in its short-acting preparation, in pregnancy is still unclear. This report provides the first documentation of uneventful octreotide LAR use during three pregnancies in a woman with bronchial carcinoid-associated adrenocorticotropic hormone-dependent Cushing's syndrome.Case presentationA 25-year-old Arabic woman presented to our emergency department with rapid onset of headache, flaring acne and hirsutism, facial puffiness, weight gain and paroxysmal myopathy, and paranoiac thoughts of rape and sexual intimidation. After undergoing surgical removal of a mass by left lower lung lobectomy, her residual lung disease medical therapy failed. Chronic octreotide LAR injections were initiated as indicated by a positive octreoscan.Follow-up revealed a long-lasting positive response to octreotide. Avidity of octreotide to somatostatin receptor sub-type 2 was later confirmed by a positive somatostatin receptor sub-type 2 in the resected tumor specimen. Against our instructions, the patient had three spontaneous pregnancies leading to delivery of three full-term healthy children while her octreotide LAR therapy continued.ConclusionThis case adds more data supporting the potential for the safe use of octreotide and the feasibility of octreotide LAR use during pregnancy, making compliance with the patient's preference not to withdraw octreotide therapy as soon as her pregnancy is confirmed a thoughtful option.

Outcome of pregnancies in a large cohort of women with acromegaly

“…However, some women decided to continue octreotide therapy throughout pregnancy and gave birth to full‐term healthy infants. These findings are in line with previous studies reporting 9 women given octreotide throughout pregnancy without any foetal complications . Concerning infants born to mothers who used octreotide during the first 5 months of gestation, we observed some adverse outcomes, including 1 preterm with low birthweight and normal Apgar (#B10), 1 term with low birthweight (#B03c) and 1 (#B03b) with congenital abnormality (ureteral stenosis).…”

“…These findings are in line with previous studies reporting 9 women given octreotide throughout pregnancy without any foetal complications. 1,10,[37][38][39][40][41] Concerning infants born to mothers who used octreotide during the first 5 months of gestation, we observed some adverse outcomes, including 1 preterm with low birthweight and normal Apgar (#B10), 1 term with low birthweight (#B03c) and 1 (#B03b) with congenital abnormality (ureteral stenosis). Regarding to small newborns for gestational age, previous studies 1,4,7,9,10,13,40,42,43 report small newborns for gestational age, without significant malformations, in women exposed to SRL for short periods during pregnancy, usually during the first trimester.…”

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

“…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).…”

Portal hypertension in pregnancy – Concealed perils

“…Octreotide has been used throughout pregnancy without evidence of fetal harm in one study of 10 women with endocrine disorders, and may be considered in the setting of variceal bleeding. 6 There are no recommendations regarding mode of delivery, which should be based upon obstetric indications. In the absence of coagulopathy or thrombocytopenia, early regional anaesthesia should be considered.…”