Endocrine Abstracts

A 34-year-old female was seen in the joint diabetic antenatal clinic during her second pregnancy. She had a very unfortunate first pregnancy, which resulted in a still birth following a traumatic delivery. She also had a large post-partum haemorrhage causing Sheehan’s syndrome. Hormone replacement therapy had been commenced, including hydrocortisone, thyroxine and growth hormone (GH). Pre-treatment quality of life assessment in GH deficient adults score (Qol-AGHDA) 21, and IGF-1 <0.2 nmol/l. She managed to conceive twins, naturally with the aid of ovarian stimulatory medication. GH was stopped at the end of the first trimester, however her symptoms returned and blood sugar control slipped. With the patients consent Genotropin was re-started at half dose with subsequent improvement in symptoms and sugar control. At 19 weeks IGF-1 13.7 nmol/l, HbA1C 5.4%.

The remainder of the pregnancy was uneventful from a diabetes perspective, however she did develop abnormal liver function tests (LFTs), ALP 230 u/l, ALT 223 u/l Bilirubin 12 μmol/l. This was felt to be cholestasis of pregnancy but given the fact she was on GH treatment the drug company were keen for further details. She delivered by elective c-section at 34 weeks after which her dose was increased to its pre-conception level. Following delivery her LFTs returned to normal.

There is little evidence of the use of recombinant GH during pregnancy. NICE guidelines state that it is contraindicated during pregnancy. Generally it is stopped at the end of the first trimester as the rise in placental GH (at around 8 weeks) is felt to be the main determinant in maternal IGF- 1. Studies have shown that placental GH can normalise IGF-1 levels in GH deficient patients during pregnancy. This case however demonstrates that there is likely to be a role for GH treatment during pregnancy.