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Acromegaly: Preconception Management

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Pituitary Disorders throughout the Life Cycle

Abstract

Family planning is an important component of the medical care for women with acromegaly. For women desiring fertility, preconception counseling should be offered to address the potential risks to the mother and fetus. The optimal time to conceive depends on disease control and the need for treatments used to manage acromegaly. Preconception evaluation also entails screening for comorbidities and managing them appropriately. We present a case of a woman with a growth hormone (GH)-secreting tumor who aims to conceive and summarize the pathophysiology and best standards regarding preconception management in this population of patients.

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References

  1. Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A consensus on the diagnosis and treatment of acromegaly comorbidities: an update. J Clin Endocrinol Metab. 2020;105(4):dgz096.

    Article  PubMed  Google Scholar 

  2. Colao A, Grasso LFS, Giustina A, Melmed S, Chanson P, Pereira AM, et al. Acromegaly. Nat Rev Dis Primers. 2019;5(1):20.

    Article  PubMed  Google Scholar 

  3. Chanson P, Vialon M, Caron P. An update on clinical care for pregnant women with acromegaly. Expert Rev Endocrinol Metab. 2019;14(2):85–96.

    Article  CAS  PubMed  Google Scholar 

  4. Huang W, Molitch ME. Pituitary tumors in pregnancy. Endocrinol Metab Clin N Am. 2019;48(3):569–81.

    Article  Google Scholar 

  5. Petersenn S, Christ-Crain M, Droste M, Finke R, Flitsch J, Kreitschmann-Andermahr I, et al. Pituitary disease in pregnancy: special aspects of diagnosis and treatment? Geburtshilfe Frauenheilkd. 2019;79(4):365–74.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jallad RS, Shimon I, Fraenkel M, Medvedovsky V, Akirov A, Duarte FH, et al. Outcome of pregnancies in a large cohort of women with acromegaly. Clin Endocrinol. 2018;88(6):896–907.

    Article  CAS  Google Scholar 

  7. Karaca Z, Yarman S, Ozbas I, Kadioglu P, Akturk M, Kilicli F, et al. How does pregnancy affect the patients with pituitary adenomas: a study on 113 pregnancies from Turkey. J Endocrinol Investig. 2018;41(1):129–41.

    Article  CAS  Google Scholar 

  8. Abucham J, Bronstein MD, Dias ML. Management of endocrine disease: acromegaly and pregnancy: a contemporary review. Eur J Endocrinol. 2017;177(1):R1–R12.

    Article  CAS  PubMed  Google Scholar 

  9. Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol. 2005;152(3):379–87.

    Article  CAS  PubMed  Google Scholar 

  10. Grynberg M, Salenave S, Young J, Chanson P. Female gonadal function before and after treatment of acromegaly. J Clin Endocrinol Metab. 2010;95(10):4518–25.

    Article  CAS  PubMed  Google Scholar 

  11. Kaltsas GA, Androulakis II, Tziveriotis K, Papadogias D, Tsikini A, Makras P, et al. Polycystic ovaries and the polycystic ovary syndrome phenotype in women with active acromegaly. Clin Endocrinol. 2007;67(6):917–22.

    Article  CAS  Google Scholar 

  12. Caron P, Broussaud S, Bertherat J, Borson-Chazot F, Brue T, Cortet-Rudelli C, et al. Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women. J Clin Endocrinol Metab. 2010;95(10):4680–7.

    Article  CAS  PubMed  Google Scholar 

  13. Montini M, Pagani G, Gianola D, Pagani MD, Piolini R, Camboni MG. Acromegaly and primary amenorrhea: ovulation and pregnancy induced by SMS 201-995 and bromocriptine. J Endocrinol Investig. 1990;13(2):193.

    Article  CAS  Google Scholar 

  14. Guven S, Durukan T, Berker M, Basaran A, Saygan-Karamursel B, Palaoglu S. A case of acromegaly in pregnancy: concomitant transsphenoidal adenomectomy and cesarean section. J Matern Fetal Neonatal Med. 2006;19(1):69–71.

    Article  PubMed  Google Scholar 

  15. Aono T, Shioji T, Kohno M, Ueda G, Kurachi K. Pregnancy following 2-bromo-alpha-ergocryptine (CB-154)-induced ovulation in an acromegalic patient with galactorrhea and amenorrhea. Fertil Steril. 1976;27(3):341–4.

    Article  CAS  PubMed  Google Scholar 

  16. Luboshitzky R, Dickstein G, Barzilai D. Bromocriptine-induced pregnancy in an acromegalic patient. JAMA. 1980;244(6):584–6.

    Article  CAS  PubMed  Google Scholar 

  17. Husebye ES, Pearce SH, Krone NP, Kämpe O. Adrenal insufficiency. Lancet. 2021;397(10274):613–29.

    Article  CAS  PubMed  Google Scholar 

  18. Bensing S, Giordano R, Falorni A. Fertility and pregnancy in women with primary adrenal insufficiency. Endocrine. 2020;70(2):211–7.

    Article  CAS  PubMed  Google Scholar 

  19. Anand G, Beuschlein F. Management of endocrine disease: fertility, pregnancy and lactation in women with adrenal insufficiency. Eur J Endocrinol. 2018;178(2):R45–53.

    Article  CAS  PubMed  Google Scholar 

  20. Petersenn S. Secondary adrenal insufficiency in pregnancy: any differences? Minerva Endocrinol. 2018;43(4):446–50.

    PubMed  Google Scholar 

  21. Langlois F, Lim DST, Fleseriu M. Update on adrenal insufficiency: diagnosis and management in pregnancy. Curr Opin Endocrinol Diabetes Obes. 2017;24(3):184–92.

    Article  CAS  PubMed  Google Scholar 

  22. Glezer A, Jallad RS, Machado MC, Fragoso MC, Bronstein MD. Pregnancy and pituitary adenomas. Minerva Endocrinol. 2016;41(3):341–50.

    PubMed  Google Scholar 

  23. Glezer A, Bronstein MD. Prolactinomas in pregnancy: considerations before conception and during pregnancy. Pituitary. 2020;23(1):65–9.

    Article  PubMed  Google Scholar 

  24. Cornejo M, Fuentes G, Valero P, Vega S, Grismaldo A, Toledo F, et al. Gestational diabesity and foetoplacental vascular dysfunction. Acta Physiol (Oxf). 2021;232:e13671.

    Article  CAS  Google Scholar 

  25. Dicuonzo F, Purciariello S, De Marco A, Guastamacchia E, Triggiani V. Inoperable giant growth hormone-secreting pituitary adenoma: radiological aspects, clinical management and pregnancy outcome. Endocr Metab Immune Disord Drug Targets. 2019;19(2):214–20.

    Article  CAS  PubMed  Google Scholar 

  26. Muhammad A, Neggers SJ, van der Lely AJ. Pregnancy and acromegaly. Pituitary. 2017;20(1):179–84.

    Article  CAS  PubMed  Google Scholar 

  27. Vila G, Jørgensen JOL, Luger A, Stalla GK. Insulin resistance in patients with acromegaly. Front Endocrinol (Lausanne). 2019;10:509.

    Article  Google Scholar 

  28. Hannon AM, Thompson CJ, Sherlock M. Diabetes in patients with acromegaly. Curr Diab Rep. 2017;17(2):8.

    Article  CAS  PubMed  Google Scholar 

  29. Dutta P, Hajela A, Gupta P, Rai A, Sachdeva N, Mukherjee KK, et al. The predictors of recovery from diabetes mellitus following neurosurgical treatment of acromegaly: a prospective study over a decade. Neurol India. 2019;67(3):757–62.

    PubMed  Google Scholar 

  30. Atmaca A, Dagdelen S, Erbas T. Follow-up of pregnancy in acromegalic women: different presentations and outcomes. Exp Clin Endocrinol Diabetes. 2006;114(3):135–9.

    Article  CAS  PubMed  Google Scholar 

  31. Association AD. 14. Management of diabetes in pregnancy. Diabetes Care. 2021;44(Suppl 1):S200–S10.

    Article  Google Scholar 

  32. Petrossians P, Daly AF, Natchev E, Maione L, Blijdorp K, Sahnoun-Fathallah M, et al. Acromegaly at diagnosis in 3173 patients from the Liège Acromegaly Survey (LAS) Database. Endocr Relat Cancer. 2017;24(10):505–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102–52.

    Article  CAS  PubMed  Google Scholar 

  34. Fleseriu M. Medical treatment of acromegaly in pregnancy, highlights on new reports. Endocrine. 2015;49(3):577–9.

    Article  CAS  PubMed  Google Scholar 

  35. Association AD. 10. Cardiovascular disease and risk management. Diabetes Care. 2021;44(Suppl 1):S125–S50.

    Article  Google Scholar 

  36. López-García R, Abarca-Olivas J, Monjas-Cánovas I, Picó Alfonso A, Moreno-López P, Gras-Albert JR. Endonasal endoscopic surgery in pituitary adenomas: surgical results in a series of 86 consecutive patients. Neurocirugia (Astur). 2018;29(4):161–9.

    Article  Google Scholar 

  37. Asha MJ, Takami H, Velasquez C, Oswari S, Almeida JP, Zadeh G, et al. Long-term outcomes of transsphenoidal surgery for management of growth hormone-secreting adenomas: single-center results. J Neurosurg. 2019:1–11. https://doi.org/10.3171/2019.6.JNS191187.

  38. Shen M, Tang Y, Shou X, Wang M, Zhang Q, Qiao N, et al. Surgical Results and Predictors of Initial and Delayed Remission for Growth Hormone-Secreting Pituitary Adenomas Using the 2010 Consensus Criteria in 162 Patients from a Single Center. World Neurosurg. 2018; 27:S1878–8750(18)32738–4. https://doi.org/10.1016/j.wneu.2018.11.179.

  39. Taghvaei M, Sadrehosseini SM, Ardakani JB, Nakhjavani M, Zeinalizadeh M. Endoscopic endonasal approach to the growth hormone-secreting pituitary adenomas: endocrinologic outcome in 68 patients. World Neurosurg. 2018;117:e259–e68.

    Article  PubMed  Google Scholar 

  40. Herman-Bonert V, Seliverstov M, Melmed S. Pregnancy in acromegaly: successful therapeutic outcome. J Clin Endocrinol Metab. 1998;83(3):727–31.

    CAS  PubMed  Google Scholar 

  41. Teltayev D, Akshulakov S, Ryskeldiev N, Mustafin K, Vyacheslav L. Pregnancy in women after successful acromegaly treatment, including surgical removal of pituitary adenoma and postoperative therapy using lanreotide acetate. Gynecol Endocrinol. 2017;33(sup1):50–1.

    Article  CAS  PubMed  Google Scholar 

  42. Graillon T, Cuny T, Castinetti F, Courbière B, Cousin M, Albarel F, et al. Surgical indications for pituitary tumors during pregnancy: a literature review. Pituitary. 2020;23(2):189–99.

    Article  CAS  PubMed  Google Scholar 

  43. Gonzalez JG, Elizondo G, Saldivar D, Nanez H, Todd LE, Villarreal JZ. Pituitary gland growth during normal pregnancy: an in vivo study using magnetic resonance imaging. Am J Med. 1988;85(2):217–20.

    Article  CAS  PubMed  Google Scholar 

  44. Dinç H, Esen F, Demirci A, Sari A, Resit Gümele H. Pituitary dimensions and volume measurements in pregnancy and post partum. MR assessment. Acta Radiol. 1998;39(1):64–9.

    PubMed  Google Scholar 

  45. Bronstein MD, Paraiba DB, Jallad RS. Management of pituitary tumors in pregnancy. Nat Rev Endocrinol. 2011;7(5):301–10.

    Article  CAS  PubMed  Google Scholar 

  46. Kasuki L, Neto LV, Takiya CM, Gadelha MR. Growth of an aggressive tumor during pregnancy in an acromegalic patient. Endocr J. 2012;59(4):313–9.

    Article  CAS  PubMed  Google Scholar 

  47. Grand’Maison S, Weber F, Bédard MJ, Mahone M, Godbout A. Pituitary apoplexy in pregnancy: a case series and literature review. Obstet Med. 2015;8(4):177–83.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Muthukumar N. Pituitary apoplexy: a comprehensive review. Neurol India. 2020;68(Supplement):S72–S8.

    PubMed  Google Scholar 

  49. Chen CJ, Ironside N, Pomeraniec IJ, Chivukula S, Buell TJ, Ding D, et al. Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications. Acta Neurochir. 2017;159(11):2193–207.

    Article  PubMed  Google Scholar 

  50. Lesén E, Granfeldt D, Houchard A, Dinet J, Berthon A, Olsson DS, et al. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol. 2017;176(2):203–12.

    Article  PubMed  Google Scholar 

  51. Fleseriu M, Biller BMK, Freda PU, Gadelha MR, Giustina A, Katznelson L, et al. A pituitary society update to acromegaly management guidelines. Pituitary. 2021;24(1):1–13.

    Article  PubMed  Google Scholar 

  52. Levine M, O’Connor AD. Obstetric toxicology: teratogens. Emerg Med Clin North Am. 2012;30(4):977–90.

    Article  PubMed  Google Scholar 

  53. Hannon AM, Frizelle I, Kaar G, Hunter SJ, Sherlock M, Thompson CJ, et al. Octreotide use for rescue of vision in a pregnant patient with acromegaly. Endocrinol Diabetes Metab Case Rep 2019;2019:19-0019.

    Google Scholar 

  54. Maffei P, Tamagno G, Nardelli GB, Videau C, Menegazzo C, Milan G, et al. Effects of octreotide exposure during pregnancy in acromegaly. Clin Endocrinol. 2010;72(5):668–77.

    Article  CAS  Google Scholar 

  55. Brian SR, Bidlingmaier M, Wajnrajch MP, Weinzimer SA, Inzucchi SE. Treatment of acromegaly with pegvisomant during pregnancy: maternal and fetal effects. J Clin Endocrinol Metab. 2007;92(9):3374–7.

    Article  CAS  PubMed  Google Scholar 

  56. van der Lely AJ, Gomez R, Heissler JF, Åkerblad AC, Jönsson P, Camacho-Hübner C, et al. Pregnancy in acromegaly patients treated with pegvisomant. Endocrine. 2015;49(3):769–73.

    Article  PubMed  CAS  Google Scholar 

  57. Persechini ML, Gennero I, Grunenwald S, Vezzosi D, Bennet A, Caron P. Decreased IGF-1 concentration during the first trimester of pregnancy in women with normal somatotroph function. Pituitary. 2015;18(4):461–4.

    Article  CAS  PubMed  Google Scholar 

  58. Wiesli P, Zwimpfer C, Zapf J, Schmid C. Pregnancy-induced changes in insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein 3 (IGFBP-3), and acid-labile subunit (ALS) in patients with growth hormone (GH) deficiency and excess. Acta Obstet Gynecol Scand. 2006;85(8):900–5.

    Article  CAS  PubMed  Google Scholar 

  59. Lau SL, McGrath S, Evain-Brion D, Smith R. Clinical and biochemical improvement in acromegaly during pregnancy. J Endocrinol Investig. 2008;31(3):255–61.

    Article  CAS  Google Scholar 

  60. Yang MJ, Tseng JY, Chen CY, Yeh CC. Changes in maternal serum insulin-like growth factor-I during pregnancy and its relationship to maternal anthropometry. J Chin Med Assoc. 2013;76(11):635–9.

    Article  CAS  PubMed  Google Scholar 

  61. Cheng V, Faiman C, Kennedy L, Khoury F, Hatipoglu B, Weil R, et al. Pregnancy and acromegaly: a review. Pituitary. 2012;15(1):59–63.

    Article  PubMed  Google Scholar 

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Jallad, R.S., Bronstein, M.D. (2022). Acromegaly: Preconception Management. In: Samson, S.L., Ioachimescu, A.G. (eds) Pituitary Disorders throughout the Life Cycle. Springer, Cham. https://doi.org/10.1007/978-3-030-99918-6_8

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  • DOI: https://doi.org/10.1007/978-3-030-99918-6_8

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