Pituitary and neuroendocrinology
Rosa Pirchiom , Renata S. Auriemma 1 , Nunzia Verde 1 , Francesco Garifalos 1 , Michele Castoro 1 , Giacomo Galdiero 1 , Mariangela Piscopo 1 , Claudia Pivonello 1 , Annamaria Colao 1,2 & Rosario Pivonello 1,2
Department of Clinical Medicine and Surgery, Section of Endocrinology and Metabolism, “Federico II’’ University of Naples, Italy.; [email protected]; 1Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy; 2UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
Fertility represents a major concern in patients with acromegaly and the peculiar PCOS-like condition is commonly found in acromegalic women. The current retrospective study aimed at investigating gonadal function and fertility rate in acromegalic women with disease onset (DO) within the reproductive age. In 50 women hormonal parameters and gynecological ultrasound were evaluated at diagnosis (DD) and after disease control (DC). Data about menstrual disturbances (MD), pregnancy desire, occurrence and outcome, and PCOS were investigated at DO, DD and DC. At presumed DO, MD were reported in 32% of patients. Uterine leiomyomata, ovarian cysts and PCOS were diagnosed in 18%, 12% and 8% of patients. Among women with pregnancy desire (37.2%), 36.9% resulted infertile. At DD, MD were found in 58.1% (P=0.02 vs DO) and were significantly more prevalent in patients with higher IGF-I quartiles (Q) (P=0.03, Q1 vs Q4). Gynecological ultrasound revealed uterine leiomyomata, ovarian cysts and PCOS in 39.1% (P=0.04), 28.3% (P=0.09), and 13.6% (P=0.55), respectively. Among those with pregnancy desire (13.9%), infertility rate was 100% (P=0.02 vs DO). At DC, 36.4% of patients still in the reproductive age have MD. MD (P=0.05) and amenorrhea (P=0.03) significantly persisted in patients with disease duration above than in those with disease duration below 5 yrs (median). Prevalence of ovarian cysts (10%, P=0.08) slightly reduced compared to DD. Among patients with pregnancy desire, 73.3% spontaneously conceived at least once, resulting in a significant decrease of infertility rate (26.7%, P=0.01) compared to DD. At-term, pre-term deliveries and spontaneous abortions were recorded in 86.7%, 3.3% and 10%, respectively, in 30 pregnancies. During gestation, 2 patients received somatostatin analogues, and one had gestational diabetes. Gonadal dysfunction and infertility are common in women with acromegaly within the reproductive age and are directly influenced by the disease status and/or duration.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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