An update on clinical care for pregnant women with acromegaly

ABSTRACT

Introduction: As pregnancy is rare in women with acromegaly, only case reports and few series have been published.

Areas covered: All case reports and publications dealing with pregnancy in patients with acromegaly were collated. Information concerning the effects of acromegaly on pregnancy outcomes, the impact of pregnancy on GH/IGF-I measurements, acromegaly comorbidity and pituitary adenoma size, the effects of treatment of acromegaly on fetus outcomes were retrieved and analyzed.

Expert commentary: Based on the small number of reported cases, pregnancy is generally uneventful, except for a potential increased incidence of gestational hypertension and diabetes mellitus. Medical therapy of acromegaly (dopamine agonists, somatostatin analogs, growth hormone-receptor antagonists) is generally interrupted before or at diagnosis of pregnancy. In very rare patients with a pituitary adenoma, particularly a macroadenoma that has not been surgically treated before pregnancy, or if a surgical remnant persists, or when acromegaly is revealed during pregnancy, tumor volume may increase and cause symptoms through a mass effect. Close monitoring of clinical manifestations and imaging are necessary during pregnancy in these cases. In the rare cases of symptomatic tumor enlargement during pregnancy, medical treatment with dopamine agonists or eventually somatostatin analogs may be attempted before resorting to transsphenoidal surgery.

KEYWORDS:

• Pituitary
• acromegaly
• pregnancy
• somatostatin analogs
• dopamine agonists
• GH-receptor antagonists
• pituitary adenomas
• mass-effect

Declaration of interest

Chanson Philippe has received unrestricted research and educational grants from Ipsen, Novartis, and Pfizer as Head of the Department of Endocrinology and Reproductive Diseases, Hôpitaux Universitaires ParisSud. He has served as investigator (principal or coordinator) for clinical trials funded by Novartis, Pfizer, Ipsen, Italpharmaco, Antisense, Chiasma. He is member of Advisory Boards for Novartis, Ipsen, and Pfizer. He gave lectures for Ipsen, Novartis, and Pfizer. All the fees and honoraria are paid to his Institution. Caron Philippe is a consultant and speaker for Ipsen, Novartis and Pfizer, and an Advisory board member for Ipsen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.