Endocrine Abstracts

To describe the course of acromegaly in a group of seven women, before, during, and after pregnancy.

Methods: Descriptive case series of acromegalic pregnant women attending a reference health center in Cali, Colombia.

Results: Mean age at conception was 29±10 years, starting prenatal care at 10±3 weeks of gestation. 6 of 7 patients had a macroadenoma as evidenced by neuroimaging (MRI). 43% (three cases) had GH and prolactin co-secretion. The mean time from the moment of diagnosis until conception was 67±32 months. Hypertension was documented in a single patient and none had diabetes mellitus. Before conception, the co-secretion of GH/IGF1 had remained under control. One patient showed normal levels of IGF1=319 ng/ml (109–483 ng/ml) with this prevailing tendency throughout pregnancy. All patients had received surgical treatment before pregnancy, with an average interval between surgery and conception of 3.3±2 years. Seven patients had undergone medical treatment prior to conception: octreotide (three cases), cabergoline (two cases), lanreotide and bromocriptine (one case each respectively). Two of the seven patients (28.6%) developed gestational diabetes, while three of seven patients (43%) developed pregnancy hypertension. All women breast-fed. During pregnancy, four women (57%) received medical treatment: lanreotide (two cases), octreotide (one case), and cabergoline (one case). 86% had cesarean delivery (n=6). GH/IGF1 levels in all patients remained elevated during the first month postpartum. Tumour size increased and decreased in two and three cases respectively, remaining unchanged in one case. Newborns had a mean gestational age of 38±1.2 weeks, average length and weight of 50.4±2.6 cm and 3,100±537 g respectively. A single case of low birth weight was documented in a newborn infant of 2,123 g. No cases of macrosomia or other comorbidities were reported.

Discussion: Although fertility is commonly impaired in acromegaly, spontaneous conceptions can occur. The patients reported here were treated with somatostatin analogs during pregnancy. Gestational diabetes and pregnancy hypertension were reported.