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Pregnancy and acromegaly: a review

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Abstract

To review the literature regarding the diagnosis and management of acromegaly during pregnancy. A systematic literature search was performed using MEDLINE including hand-searching reference lists from original articles. The diagnosis of acromegaly during pregnancy is made difficult due to the physiologic changes in pituitary GH secretion and IGF-1 production resulting from placental GH secretion and the inability of commercial assays to discriminate between pituitary and placental GH. Most patients with acromegaly during pregnancy do not have an increase in tumor size, metabolic complications are uncommon, and neonatal outcome is largely unaffected. IGF-1 levels tend to be stable in such patients possibly due to the high estrogen levels causing GH resistance. Dopamine agonists, somatostatin analogues, and a GH receptor antagonist have been reported to be safe during pregnancy. Patients with visual field defects should be considered for surgery, but in most cases this can be safely postponed until after delivery. Overall, pregnancy in acromegaly is uneventful and newborns unaffected. Dopamine agonists and somatostatin analogues have not been associated with major adverse effects to the fetus; however, more data are needed to validate their safety.

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References

  1. Herman-Bonert V, Seliverstov M, Melmed S (1998) Pregnancy in acromegaly: successful therapeutic outcome. J Clin Endocrinol Metab 83:727–731

    Article  PubMed  CAS  Google Scholar 

  2. Grynberg M, Salenave S, Young J, Chanson P (2010) Female gonadal function before and after treatment of acromegaly. J Clin Endocrinol Metab 95:4518–4525

    Article  PubMed  CAS  Google Scholar 

  3. Frankenne F, Closset J, Gomez F, Scippo ML, Smal J, Hennen G (1988) The physiology of growth hormones (GHs) in pregnant women and partial characterization of the placental GH variant. J Clin Endocrinol Metab 66:1171–1180

    Article  PubMed  CAS  Google Scholar 

  4. Beckers A, Stevenaert A, Foidart JM, Hennen G, Frankenne F (1990) Placental and pituitary growth hormone secretion during pregnancy in acromegalic women. J Clin Endocrinol Metab 71:725–731

    Article  PubMed  CAS  Google Scholar 

  5. Lau SL, McGrath S, Evain-Brion D, Smith R (2008) Clinical and biochemical improvement in acromegaly during pregnancy. J Endocrinol Invest 31:255–261

    PubMed  CAS  Google Scholar 

  6. Colao A, Merola B, Ferone D, Lombardi G (1997) Acromegaly. J Clin Endocrinol Metab 82:2777–2781

    Article  PubMed  CAS  Google Scholar 

  7. Cozzi R, Attanasio R, Barausse M (2006) Pregnancy in acromegaly: a one-center experience. Eur J Endocrinol 155:279–284

    Article  PubMed  CAS  Google Scholar 

  8. Leung KC, Johannsson G, Leong GM, Ho KK (2004) Estrogen regulation of growth hormone action. Endocr Rev 25:693–721

    Article  PubMed  CAS  Google Scholar 

  9. Molitch ME (2006) Pituitary disorders during pregnancy. Endocrinol Metab Clin North Am 35:99–116

    Article  PubMed  Google Scholar 

  10. Yap AS, Clouston WM, Mortimer RH, Drake RF (1990) Acromegaly first diagnosed in pregnancy: the role of bromocriptine therapy. Am J Obstet Gynecol 163:477–478

    PubMed  CAS  Google Scholar 

  11. Hisano M, Sakata M, Watanabe N, Kitagawa M, Murashima A, Yamaguchi K (2006) An acromegalic woman first diagnosed in pregnancy. Arch Gynecol Obstet 274:171–173

    Article  PubMed  Google Scholar 

  12. Takeuchi K, Funakoshi T, Oomori S, Maruo T (1999) Successful pregnancy in an acromegalic women treated with octreotide. Obstet Gynecol 93:848

    Article  PubMed  CAS  Google Scholar 

  13. Okada Y, Morimoto I, Ejima K, Yoshida K, Kashimura M, Fujihira T, Eto S (1997) A case of active acromegalic woman with a marked increase in serum insulin-like growth factor-1 levels after delivery. Endocr J 44:117–120

    Article  PubMed  CAS  Google Scholar 

  14. McIntyre HD, Russell A, Serek R, Veveris-Lowe T, Cotterill A, Cowley D, Barnard R (2002) Placental growth hormone is not suppressed by oral glucose loading in normal human pregnancy. Horm Metab Res 34:250–253

    Article  PubMed  CAS  Google Scholar 

  15. Caron P, Broussaud S, Bertherat J, Borson-Chazot F, Brue T, Cortet-Rudelli C, Chanson P (2010) Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women. J Clin Endocrinol Metab 95:4680–4687

    Article  PubMed  CAS  Google Scholar 

  16. Atmaca A, Dagdelen S, Erbas T (2006) Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp Clin Endocrinol Diabetes 114:135–139

    Article  PubMed  CAS  Google Scholar 

  17. Kupersmith MJ, Rosenberg C, Kleinberg D (1994) Visual loss in pregnant women with pituitary adenomas. Ann Intern Med 121:473–477

    PubMed  CAS  Google Scholar 

  18. Montini M, Pagani G, Gianola D, Pagani MD, Piolini R, Camboni MG (1990) Acromegaly and primary amenorrhea: ovulation and pregnancy induced by SMS 201–995 and bromocriptine. J Endocrinol Invest 13:193

    PubMed  CAS  Google Scholar 

  19. Lunardi P, Rizzo A, Missori P, Fraioli B (1991) Pituitary apoplexy in an acromegalic woman operated on during pregnancy by transphenoidal approach. Int J Gynaecol Obstet 34:71–74

    Article  PubMed  CAS  Google Scholar 

  20. Guven S, Durukan T, Berker M, Basaran A, Saygan-Karamursel B, Palaoglu S (2006) A case of acromegaly in pregnancy: concomitant transsphenoidal adenomectomy and cesarean section. J Matern Fetal Neonatal Med 19:69–71

    Article  PubMed  Google Scholar 

  21. Mozas J, Ocon E, de la Lopez Torre M, Suarez AM, Miranda JA, Herruzo AJ (1999) Successful pregnancy in a woman with acromegaly treated with somatostatin analog (octreotide) prior to surgical resection. Int J Gynaecol Obstet 65:71–73

    Article  PubMed  CAS  Google Scholar 

  22. Verhaeghe J (2008) Does the physiological acromegaly of pregnancy benefit the fetus? Gynecol Obstet Invest 66:217–226

    Article  PubMed  CAS  Google Scholar 

  23. Davenport ML, Clemmons DR, Miles MV, Camacho-Hubner C, D’Ercole AJ, Underwood LE (1990) Regulation of serum insulin-like growth factor-I (IGF-I) and IGF binding proteins during rat pregnancy. Endocrinology 127:1278–1286

    Article  PubMed  CAS  Google Scholar 

  24. Krupp P, Monka C (1987) Bromocriptine in pregnancy: safety aspects. Klin Wochenschr 65:823–827

    Article  PubMed  CAS  Google Scholar 

  25. Fassnacht M, Capeller B, Arlt W, Steck T, Allolio B (2001) Octreotide LAR treatment throughout pregnancy in an acromegalic woman. Clin Endocrinol (Oxf) 55:411–415

    Article  CAS  Google Scholar 

  26. Maffei P, Tamagno G, Nardelli GB, Videau C, Menegazzo C, Milan G, Calcagno A, Martini C, Vettor R, Epelbaum J, Sicolo N (2010) Effects of octreotide exposure during pregnancy in acromegaly. Clin Endocrinol (Oxf) 72:668–677

    Article  CAS  Google Scholar 

  27. Neal JM (2000) Successful pregnancy in a woman with acromegaly treated with octreotide. Endocr Pract 6:148–150

    PubMed  CAS  Google Scholar 

  28. Mikhail N (2002) Octreotide treatment of acromegaly during pregnancy. Mayo Clin Proc 77:297–298

    Article  PubMed  Google Scholar 

  29. Caron P, Gerbeau C, Pradayrol L (1995) Maternal-fetal transfer of octreotide. N Engl J Med 333:601–602

    Article  PubMed  CAS  Google Scholar 

  30. Caron P, Buscail L, Beckers A, Esteve JP, Igout A, Hennen G, Susini C (1997) Expression of somatostatin receptor SST4 in human placenta and absence of octreotide effect on human placental growth hormone concentration during pregnancy. J Clin Endocrinol Metab 82:3771–3776

    Article  PubMed  CAS  Google Scholar 

  31. de Menis E, Billeci D, Marton E, Gussoni G (1999) Uneventful pregnancy in an acromegalic patient treated with slow-release lanreotide: a case report. J Clin Endocrinol Metab 84:1489

    Article  PubMed  Google Scholar 

  32. van der Lely AJ, Hutson RK, Trainer PJ, Besser GM, Barkan AL, Katznelson L, Klibanski A, Herman-Bonert V, Melmed S, Vance ML, Freda PU, Stewart PM, Friend KE, Clemmons DR, Johannsson G, Stavrou S, Cook DM, Phillips LS, Strasburger CJ, Hackett S, Zib KA, Davis RJ, Scarlett JA, Thorner MO (2001) Long-term treatment of acromegaly with pegvisomant, a growth hormone receptor antagonist. Lancet 358:1754–1759

    Article  PubMed  Google Scholar 

  33. Qureshi A, Kalu E, Ramanathan G, Bano G, Croucher C, Panahloo A (2006) IVF/ICSI in a woman with active acromegaly: successful outcome following treatment with pegvisomant. J Assist Reprod Genet 23:439–442

    Article  PubMed  Google Scholar 

  34. Brian SR, Bidlingmaier M, Wajnrajch MP, Weinzimer SA, Inzucchi SE (2007) Treatment of acromegaly with pegvisomant during pregnancy: maternal and fetal effects. J Clin Endocrinol Metab 92:3374–3377

    Article  PubMed  CAS  Google Scholar 

  35. Landolt AM, Schmid J, Wimpfheimer C, Karlsson ER, Boerlin V (1989) Successful pregnancy in a previously infertile woman treated with SMS-201–995 for acromegaly. N Engl J Med 320:671–672

    PubMed  CAS  Google Scholar 

  36. Hierl T, Ziegler R, Kasperk C (2000) Pregnancy in persistent acromegaly. Clin Endocrinol (Oxf) 53:262–263

    Article  CAS  Google Scholar 

  37. Takano T, Saito J, Soyama A, Ito H, Iizuka T, Yoshida T, Nishikawa T (2006) Normal delivery following an uneventful pregnancy in a Japanese acromegalic patient after discontinuation of octreotide long acting release formulation at an early phase of pregnancy. Endocr J 53:209–212

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Ave, Desk F20, Cleveland, OH, 44195, USA

    Vicky Cheng, Charles Faiman, Laurence Kennedy, Betul Hatipoglu & Amir Hamrahian

  2. Obstetric and Gynecology Institute, Cleveland Clinic, Cleveland, OH, USA

    Fadi Khoury

  3. Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Robert Weil

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  1. Vicky Cheng
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  2. Charles Faiman
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  3. Laurence Kennedy
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  7. Amir Hamrahian
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Correspondence to Amir Hamrahian.

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Cheng, V., Faiman, C., Kennedy, L. et al. Pregnancy and acromegaly: a review. Pituitary 15, 59–63 (2012). https://doi.org/10.1007/s11102-011-0330-3

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