Endocrine Abstracts

Acromegaly in pregnancy is rare. There is limited literature on the use of medical therapy to treat this condition. We report for the first time somatostatin analogue use in a woman presenting with newly diagnosed Acromegaly in pregnancy to treat visual field loss.

This is the case of a 32 year old woman with a background of anxiety, depression, asthma and smokes. The patient underwent brain imaging for recurrent headache at 11 weeks gestation. At this time a pituitary mass was noted. She was referred to our endocrinology department and was found to be clinically acromegalic at 13/40 gestation. At this time visual field loss was found on visual field testing.

MRI showed 3.2×2.7×2.8 cm mass with significant compression of the infundibulum and optic chiasm. Our patient opted for medical therapy and was initiated on 100 micrograms tds Octreotide subcutaneously. Visual fields completely recovered on repeat visual field testing after 2 weeks.

Gestational diabetes evolved which improved on somatostatin therapy. Our patient remained normotensive throughout pregnancy.

At 24/40 gestation there was further deterioration in visual fields, at which point we uptitrated Octreotide dose to 150 micrograms tds. This once again allowed return of visual fields to normal within 2 weeks. (Images available)

Foetal growth continued along the 50^th centile throughout pregnancy.

An elective caesarean section was planned at 34/40. Foetal weight was 3.2 Kg at birth with an APGAR score of 9.

This patient currently continues on 200 micrograms tds octreotide.

She is menstruating regularly post partum. Her basal labs post partum showed normal thyroid function and prolactin. Random GH was 9.81 ug/L and IGF-1 was 460 ug/L. HbA1c is 40 mmol/mol.

This is the first case we are aware of where octreotide was used to treat visual field deficit in the setting of Acromegaly newly diagnosed in pregnancy.