Endocrine Abstracts

Introduction: Pregnancy in patients with acromegaly is a rare and challenging medical situation. Here in, we report a patient with acromegaly who presented to us in the 3^rdtrimester of pregnancy after endoscopic transnasaltranssphenoidal radical excision of the tumor.

Observation: A 36-year-old lady (Gravida 3 Parity 2 Live Birth 2), presented to our outpatient clinic on May 2007 forsuspicion of acromegaly. Clinical examination revealed acromegalic features. Hormonal profile revealed elevated human growth hormone (HGH) 47.3 μUI/l and insulin-like growth factor 1 (IGF-1) 576 ng/ml (normal 109–358 ng/ml), her serum prolactin PRL was also mildly elevated 76.7 ng/ml Follicle-stimulating hormone (FSH), luteinizing hormone (LH), Thyroid stimulating hormone (TSH) and Free Thyroxine (FT₄) were within normal range. Cortisol level during hypoglycaemia insulin test was 73 and 107 μg/l. Magnetic resonance imaging of the pituitary gland revealed: Left postero-lateral intra-pituitary expansive lesion measuring 17×11 mm with extension to the sphenoid sinus. Final diagnosis was: Pituitary macro-adenoma on GH, with Hyperprolactinemia and Secondary adrenal insufficiency. She underwent endoscopic transnasaltranssphenoidal radical excision of the tumor on Mars 2009. Magnetic resonance imaging of the pituitary gland after surgery revealed: Absence of evidence of adenomatous residue. On June 2010, patient present in 3^rd trimester of the pregnancy. Ophthalmological examination, hormonal profile and Oral glucose tolerance test (OGTT) of 75 gr glucose were without anomaly. She then went on to deliver a full-term baby girl by caesarean section in August 2010.

Discussion: Pregnancy in a patient with acromegaly is very unusual, as the enlarging pituitary adenoma suppresses gonadotropin secretion rendering the patient amenorrheic and infertile. Up to 30% of HGH-secreting pituitary adenomas also secrete prolactin and this adds to the problem.Although pregnancy is unusual in acromegaly, it is by no means rare.