Two successful pregnancies in a woman with active acromegaly

Abstract

Acromegaly is a rare systemic disease, predominantly caused by growth hormone (GH)-secreting pituitary adenoma, leading to insulin-like growth factor-1 (IGF-1) overproduction. Pituitary adenoma extension and/or its treatment can cause infertility or subfertility in both sexes in different mechanisms. Pregnancies in women with active acromegaly are rarely observed but considered generally safe. Growth hormone and IGF-1 concentrations are usually stable during pregnancy and in most cases no significant tumour expansion emerges despite pharmacological therapy withdrawal.

A 28 year-old woman with symptoms of acromegaly and amenorrhoea was admitted to the Department of Endocrinology. Diagnosis of acromegaly was made and treatment with somatostatin analogues (SSA) was initiated with subsequent surgical intervention. However, persistent acromegaly was diagnosed post-operatively due to residual tumour and the medical treatment was restarted. During follow-up the patient became pregnant twice and then treatment with somatostatin analogues was ceased. Both pregnancies were complicated by gestational diabetes and in the course of the second pregnancy treatment with dopamine agonist (DA) was commenced to alleviate persistent headaches and it was followed by clinical and biochemical improvement. The patient successfully delivered two healthy babies. After second labour treatment with SSA was resumed and the patient has achieved adequate disease control.

The risk of pregnancy complications in women with acromegaly is slightly higher than in general population, especially if uncontrolled disease was present before conception or acromegaly was diagnosed during pregnancy. In rare cases pituitary tumour expansion during pregnancy occurs and then pharmacological or surgical interventions should be considered.