Endocrine Abstracts

In purpose to characterize the disturbances of menstrual function in acromegalic women of reproductive age, we investigated 19 women with de novo acromegaly diagnosed at the age of 19–37 (median age 28) years. Before diagnosis, an average duration of acro-signs was 3.8 years, after diagnosis we observed women for 5 years. Among the first meaningful symptoms menstrual irregularities and/or infertility were noted in 13 (73.7%) cases. Initial levels of GH were 71 (31–135) mMe/l, IGF-1 775 (638–971) ng/ml, hyperprolactinemia was noticed in four (21%) cases. Macro-/microadenomas were found in 17/2 (89.5/10.5%) cases. Most of the patients (n=12, 63.2%) had neurosurgery, afterwards eight of them started therapy with somatostatin analogues (SSA). Seven (36.8%) patients received only medical therapy (n=5 SSA; n=2 SSA+dopamine agonists). After treatment seven (36.8%) patients had controlled acromegaly (four after surgery, three on SSA), in other patients GH and IGF-1 levels were above target criteria. Menstrual disturbances were observed in four (21.1%) cases (persisted in two patients, and a hypogonadotropic hypogonadism developed after surgical treatment in two women with initially normal menstrual cycle). In other women with initial menstrual dysfunction a restoration of the normal menstrual cycle was noted due to basal treatment of acromegaly. Three patients became pregnant during treatment with SSA (two with controlled acromegaly and one with partially controlled), one of them wished to terminate a pregnancy, two others did not stop the SSA therapy and gave birth in time to healthy babies.

Conclusions: Different menstrual cycle disorders coincided with the first symptoms of acromegaly in women of reproductive age. Algorithm of examination of women in reproductive age should include a minimum screening for acromegaly. We support the point of view that SSA therapy (in our study – Sandostatin LAR) is not harmful for a fetus and could be continued during pregnancy in women with acromegaly.