Abstract Introduction Acromegaly is often associated with menstrual dysfunction and infertility due to secondary hypogonadism and/or hyperprolactinemia in women of reproductive age. However, this does not exclude the possibility of pregnancy and the birth of a healthy child; only about 160 cases have been described in the literature. We would like to present a clinical case of successful management of pregnancy in a patient with uncontrolled acromegaly. Clinical case Female, at age 30 a spontaneous pregnancy occurred, the child died at 8 months due to Arnold-Chiari syndrome. At age 33 the second pregnancy ended in a natural delivery and the birth of a healthy child. Since that she noted swelling, an increase in the size of her extremities, at age 35 – hypertension up to 180/100 mm Hg, pain in the knee and ankle joints, and decreased vision. MRI revealed a pituitary macroadenoma 15х18х21 mm. The tests showed IGF-1 467 ng/ml (41-246), prolactin 25.9 ng/ml (4.79-23.3). Neurosurgery was performed, immunohistochemical analysis showed an expression of somatostatin receptors type 2, Ki-67 index 6%; 3 months after IGF-1 379 ng/ml, lanreotide therapy was initiated. Despite medical treatment, acromegaly was uncontrolled, IGF-1 level increased to 598 ng/ml. At age 38 an unplanned pregnancy was detected (gestational age 8 weeks). The last injection of lanreotide was a month ago, IGF-1 246 ng/ml, and the drug was cancelled. Visual field were monitored regularly during pregnancy - without negative dynamics. Non-contrast pituitary MRI at 24 weeks revealed a macroadenoma of 15x17x17,8 mm. Also, in the 1st trimester, gestational diabetes mellitus was diagnosed; diet therapy was prescribed, and later in the 3rd trimester, insulin therapy was initiated. Delivery was at 41 weeks via cesarean section, without complications. One month later MRI showed a little increase of macroadenoma 17x22x21 mm, IGF-1 487 ng/ml. The patient was advised to stop lactation and resume lanreotide therapy, but she refused and continued breastfeeding. After 8 months she noted a decrease in vision and headache, IGF-1 increased up to 810 ng/ml. Computer perimetry showed scotomas in the superotemporal quadrant, on MRI adenoma 19x25x22 mm with chiasm compression. Repeat neurosurgical treatment was recommended. Conclusion This clinical case demonstrates the possibility of pregnancy occurring even despite an aggressive course of acromegaly that was resistant to combined (surgery and lanreotide) treatment. An interesting fact is the lack of disease progression during pregnancy and the rather rapid deterioration after delivery. This may serve as a basis for more rigorous monitoring of disease activity postpartum and highlights the importance of lactation cessation if therapy needs to be resumed.
Kats et al. (Thu,) studied this question.