Endocrine Abstracts

Introduction: Acromegaly is preferentially treated by surgery and/or radiotherapy before pregnancy, in order to avoid use of medication during pregnancy, and prevent GH excess related complications for mother and child. Only two cases of use of pegvisomant during pregnancy have been described; in one patient medication was discontinued after the first trimester, and in the other pegvisomant was used as monotherapy.

Case report: A 29-years old female had been treated for acromegaly with transsphenoidal surgery. Before surgery she started with octreotide. Surgery was incomplete, and pegvisomant was added because of insufficient control. Radiotherapy was proposed, but denied by the patient. We advised against pregnancy while using pegvisomant and octreotide, but she was adamant and became pregnant at the age of 32, and was under strict medical control during pregnancy. Pregnancy was uneventful. During pregnancy, her IGF1 levels declined from 39.8 to 19.4 nmol/l with unchanged doses of 30 mg octreotide LAR once every 3 weeks, and pegvisomant 40 mg twice weekly, as before pregnancy. A healthy child was born after a full term uneventful pregnancy. After pregnancy, IGF1 levels rose to values consistent with those before pregnancy. The levels of octreotide and pegvisomant were measured in peripheral blood samples from the mother and in umbilical cord blood samples taken immediately after birth. Octreotide levels in the mother’s blood: 2142.790 and in umbilical cord blood: 807.106 pg/ml, pegvisomant levels in the mother’s blood: 1543 ng/ml, and in umbilical cord blood: undetectable.

Conclusion: We report the first successful pregnancy in an acromegalic patient using the combination of pegvisomant and octreotide during complete pregnancy. There were no congenital malformations. Pegvisomant (80 mg weekly), was not detectable in umbilical cord blood, while detectable in the mother’s blood. Octreotide was detectable, albeit in lower levels in umbilical cord blood than in the mother’s blood.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.