Endocrine Abstracts

Acromegaly is a rare disease characterised by excessive Growth Hormone production. Subfertility is common in acromegaly and has various aetiologies, therefore pregnancy in acromegaly is rare. The limited data that is available would suggest that pregnancy in acromegaly is generally safe. However, there have been reports of tumour expansion during pregnancy. Here we present a case of first presentation of acromegaly in pregnancy and subsequent rescue of visual field loss with somatostatin analogue therapy. A 32 year old woman presented at 11 week’s gestation of a planned pregnancy to her local hospital with headaches. She had a past medical history of asthma and depression. A CT brain demonstrated a pituitary lesion. She was referred to her regional endocrine centre and was noted to have features of acromegaly. She had an oral glucose tolerance test at 12/40 to confirm the diagnosis; her plasma glucose concentrations were in the normal range, however she failed to suppress her plasma GH. Her IGf-1 was also significantly elevated at 82 nmol/L (normal range 9–33 nmol/L). MRI confirmed a 3.2×2.7×2.8 cm mass with significant compression of the infundibulum and optic chiasm. She had a left upper quadrantanopia visual field loss on formal testing. On discussion of both surgical and medical options our patient opted for medical therapy and was initiated on 100 micrograms tds Octreotide subcutaneously at 16/40. Visual fields completely recovered on repeat visual field testing after 2 weeks. At 24/40 there was further deterioration in visual fields, at which point we increased the Octreotide dose to 150 micrograms tds. This once again allowed return of visual fields to normal within 2 weeks. She was diagnosed with gestational diabetes when screened at 14/40. She was initially treated with diet modifications but was commenced on insulin at 22/40 due to elevated fasting capillary glucose readings. There was no significant increase in insulin requirements following the increase in octreotide dose. She remained normotensive throughout pregnancy. Foetal growth continued along the 50th centile throughout pregnancy. An elective caesarean section was planned at 34/40. The foetal weight was 3.2 kg at birth with an APGAR score of 9. She is menstruating regularly post-partum. She is currently stable on 40 mg octreotide LAR and has been referred for surgical intervention. 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.