Endocrine Abstracts

Growth hormone (GH) producing tumors are commonly associated with menstrual disorders and anovulation because of the direct effects of tumor mass on gonadotropins and possible association with hyperprolactinemia. However, some women with acromegaly get pregnant, which rises up a lot of questions about medication, complications and follow-up. We report outcomes of 7 cases of pregnancy in patients with active acromegaly. A median age of patients was 30 years, four of them were with macroadenoma and 3 - microsomatotropinoma. All women had elevated levels of GH and IGF-1 at the period of conception – 7.6 ng/ml [6.1;16.4] and 550 ng/ml [453.7;674.5], respectively. Three patients also had a mild hyperprolactinemia, two women previously underwent transnasal adenomectomy and one – radiation therapy without complete affect. Only three women had regular menstrual function, two had amenorrhea and two – oligomenorrhea. In 57% of cases patients got pregnant during complex therapy with octreotide (mean dose 20 mg per 28 days) and cabergoline (mean dose 1 mg per week), period of treatment before conception varied from 1 to 35 months. Of 7 pregnancies only 5 resulted in births, in one patient, with diabetes mellitus and poor glucose control, a spontaneous miscarriage was registered at 9 weeks of gestation and one woman required medical abortion at 10 weeks due to the episodes of severe hypotension. The average gestational duration was 39 weeks. Preterm delivery occurred in one woman at 24 weeks that led to newborn death, other children were healthy (average height – 52.3 cm, weight – 3332.5 g). These clinical cases demonstrate that women with acromegaly do have a reproductive potential in spite of menstrual disorders and a lot of comorbidities. Pregnancy in active stage of the disease can be complicated by miscarriage and preterm delivery. So preconception counselling and intensive monitoring during gestation is necessary for successful pregnancy and neonatal outcome.