Endocrine Abstracts

Introduction: GH producing pituitary adenomas are associated with infertility. Hereby the first case in Lithuania, when acromegaly patient got pregnant and delivered is reported.

Case presentation: 33-year-old woman visited endocrinologist complaining of secondary amenorrhoea. Due to elevated prolactin – 3016 mU/l (NR<418), bromcriptine treatment was started. The patient discontinued treatment after three months because of restoration of regular menstrual cycle and dropped out from follow-up. Four years later the patient visited our hospital having complaints of typical acromegaly symptoms. Her IGF-1 was 150.7 nmol/l (x3 ULN). Pituitary MRI disclosed a macroadenoma 1.6×1.2×0.6 cm. Total macroadenoma’s removal was not possible, because of invasion into left cavernous sinus, there was no visual impairment, so the patient was enrolled into the III phase clinical trial and treated with subcutaneous injections of study drug (dopamine-somatostatine chimeric molecule). Due to insufficient effect, treatment was discontinued. One month later IGF-1 was 846.9 ng/ml (x3.4 ULN). Transsphenoidal resection of adenoma was performed, pathological examination confirmed GH/TSH secreting cells. Three months later, treatment with somatostatin analogues was started due to GH and IGF-1 hypersecretion and continued for 280 days, giving Lanreotide 120mg every 56 days for the last three injections. When patient came for fourth Lantreotide dose, she was pregnant for 6 weeks and treatment was discontinued. Normal fetal growth and development was observed, with no maternal complications. The patient delivered a full-term 4060 g weight, 52 cm height new-born and APGAR 9–10 points by caesarean section. Lanreotide therapy was restarted in three months. Seven months after delivery MRI scan disclosed reduced adenoma size, hormone levels decreased as well.

Conclusion: The case of successful pregnancy in patient with active GH secreting adenoma, treated with Lanreotide, is presented. Only a few such cases are reported worldwide. Although lanreotide is assigned to category C by FDA, no pregnancy complications were observed in our case.