Endocrine Abstracts

Introduction: Abnormalities of glycoregulation are frequent in acromegaly (15-38%) secondary to insulin resistance related to GH/IGF-1 hyper-secretion. The frequency of gestational diabetes (GD) in women with acromegaly was reported in the French multicenter study (JCEM, 2010, 95, 4680) as increased mainly in the absence of pre-gestational control of GH/IGF-1 hyper-secretion. The aim of this study was to evaluate the frequency of GD in a cohort of acromegalic women, and compare characteristics of women with (GD+) or without GD (GD-).

Patients and methods: This is a descriptive monocentric study of 14 pregnancies in 11 women (mean age: 34.0±3.6 years) followed for GH-secreting pituitary macro-adenomas. They were treated with first generation long-acting somatostatin analogues (octreotide LAR n=3, mean dose 30 mg/month; lanreotide Autogel n=11, mean dose 95±26 mg/month) after a pituitary surgery (n=6) or as primary (n=5) treatment. Somatostatin analogues were discontinued during 1^st trimester, at the time of pregnancy diagnosis. One acromegaly was diagnosed during pregnancy and was treated with octreotide LAR between 12 and 18 weeks of gestation. Before pregnancy, no woman had diabetes mellitus, and GH/IGF-1 hyper-secretion was uncontrolled in 6 women (mean IGF-1: 176% upper limit of normal range).

Results: A GD was diagnosed in 7 pregnancies (50%) on fasting blood glucose in 1st trimester (n=5) or an oral glucose tolerance test at 3rd trimester (n=2). Insulin treatment was necessary for 4 patients. Before pregnancy, IGF-1 was not controlled in 4 of GD+ and 2 in GD- women. Women with GD were older (GD+35.3 years, GD- 32.7 years, P=0.20), had increased pre-gestational BMI (GD+26 kg/m², GD- 20.7 kg/m², P=0.02), had frequently family history of type 2 diabetes mellitus (GD+3, GD- 0), no history of GD but a history of macrosomia for one patient. The percentile birth weight of newborns was on average 48.7 for GD + and 69.4 for GD- mothers (P=0.15).

Conclusion: In this cohort of acromegalic women, the prevalence of GD is increased compared to that reported in the literature, probably secondary to systematic GD screening and to the age of our women (73% were ≥35 years old). Therefore, routine screening of GD should be considered in all women with acromegaly, particularly those with risk factors for the occurrence of GD and with uncontrolled IGF-1.