Endocrine Abstracts

Introduction: Pregnancy in a patient with acromegaly is uncommon, as the enlarging pituitary adenoma suppresses gonadotropin secretion rendering the patient amenorrhoeic and infertile. About 40% of the women with pituitary adenomas also have hyperprolactinaemia, which further decreases the likelihood of pregnancy.

Case report: A 32-year-old woman was sent to our centre in the first trimester of pregnancy with the diagnostic of gestational diabetes. Clinical examination revealed acromegalic features. Her blood pressure was normal. A few weeks before getting pregnant, because of a history of headaches and amenorrhoea, she underwent a brain magnetic resonance imaging (MRI) that showed a pituitary macroadenoma, with left cavernous sinus invasion but without compression of the optic chiasma. However, this result became available when she was already pregnant. Hormonal profile revealed elevated GH (80 ng/ml) and IGF1 (1442 ng/ml). Prolactin was also mildly elevated (38 ng/ml). She had no changes in visual acuity, visual fields, or fundus. She was medicated only with insulin for her diabetes, with excellent control. Serial visual field monitoring was performed, which remained normal, and signs and symptoms of acromegaly were stable. She delivered a full-term baby girl by caesarean section, healthy and without any malformations. Three months later, octreotide 20 mg once a month was started, with progressive decrease in GH and IGF1. After 6 months of treatment, a new MRI was performed showing a significant reduction of the tumour. She is now under octreotide 30 mg once a month and about 1 year after the beginning of somastostatin analogue the IGF1 level is 578 ng/ml, GH 3 ng/ml, and prolactin 19.7 ng/ml. Her acromegalic features had regressed.

Conclusion: Pregnancy in women with acromegaly can have a normal course, without obstetrical or foetal complications, and treatment can be postponed to the postpartum period.