Endocrine Abstracts

Introduction: Reports of pregnancy occurring in acromegalic patients are uncommon. Nevertheless, it appears that women are usually able to carry their pregnancy to full term

Case: 39 year old woman referred to endocrinology for secondary amenorrhea and hyperprolactinemia (PRL 55.54 mg/dl). As she mentioned typical symptoms of Acromegaly, we extended the study, finding high levels of IGF1 and a pituitary macroadenoma (25×16 mm) in MRI. Presurgical treatment with Octreotide was started (120 mg/28 days) and complete transsphenoidal surgical resection of GH/PRL secreting pituitary adenoma was performed. 6 months later, as IGF1 levels and GH during oGTT remained high, and no biochemical remission was achieved, treatment with octreotide and cabergoline was restarted. 13 months later, she got unexpectedly pregnant and pharmacological treatment was withdrawn as soon as pregnancy was diagnosed (7–9 weeks). Patient was clinically and biochemically evaluated throughout pregnancy with at least one visit per trimester. In spite of medical treatment withdrawal, IGF significantly decreased compared to preconceptional values. Normal fetal growth and development was observed, with no maternal complications (gestational diabetes or gravid hypertension) and no congenital malformations in the newborn. After delivery IGF1 increased to pregestational levels. During the postpartum period, there was no problem for breastfeeding until medical treatment was restarted.

Discussion: Several reports conclude that GH-supressive treatment can be safely withdrawn after conception in most women with acromegaly. In this case, withdrawal of octreotide and cabergoline was safe for obstetrical and fetal outcomes with an uneventful course of pregnancy and delivery, with a helthy newborn.