title: Acromegaly and pregnancy: a retrospective multicenter study of 59 pregnancies in 46 women.
abstract: BACKGROUND
  Few data are available on pregnancy outcomes in women with acromegaly.
  
  
  METHODS
  This was a retrospective multicenter study.
  
  
  METHODS
  The study included 46 women with GH-secreting pituitary microadenomas (n = 7) or macroadenomas (n = 39). Their mean age was 31.7 yr (±4.5 yr). Incomplete transsphenoidal surgical resection (n = 39) and pituitary radiation (n = 14) had been performed, respectively, 2.9 ± 2.6 and 7.3 ± 4.2 yr before pregnancy. The patients were receiving dopamine agonists (n = 25) and/or somatostatin analogs (n = 14), and GH/IGF-I hypersecretion was controlled and uncontrolled in, respectively, 23 and 34 cases. Five pregnancies followed the fertility treatment.
  
  
  RESULTS
  Fifty-nine pregnancies resulted in 64 healthy babies. Gestational diabetes and gravid hypertension occurred in four (6.8%) and eight (13.6%) pregnancies, respectively, and both were more frequent when GH/IGF-I hypersecretion was not controlled before pregnancy. Visual field defects were diagnosed during pregnancy in four women, three of whom were diagnosed with acromegaly during the pregnancy. Seven women had isolated headache. Magnetic resonance imaging performed 3.9 ± 0.3 months after delivery showed that the size of the adenoma had increased in three cases, decreased in two cases, and remained stable in 22 cases. Seventeen women breast-fed with no complications. Four women gave birth to a small-for-gestational-age infant; all had received somatostatin analogs, alone or in combination with dopamine agonists, during pregnancy. The mean IGF-I level fell significantly during the first trimester in 12 cases (before conception 588 ± 207 ng/ml, first trimester 319 ± 126 ng/ml, P = 0.002), whereas the GH concentration did not change significantly.
  
  
  CONCLUSIONS
  The following conclusions were reached: 1) pregnancy in women with active or uncontrolled acromegaly may be associated with an increased risk of gestational diabetes and gravid hypertension; 2) pregnancy is occasionally associated with symptomatic enlargement of GH-secreting pituitary macroadenomas; 3) changes in serum GH and IGF-I concentrations are variable during pregnancy, indicating that routine monitoring is not mandatory if the pregnancy is uneventful; and 4) GH-suppressive treatment can be safely withdrawn after conception in most acromegalic women.
authors.affiliation: Service d'Endocrinologie, Maladies Métaboliques, et Nutrition, Centre Hospitalier Universitaire Larrey, Toulouse, France. caron.p@chu-toulouse.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Broussaud
authors.forename: Jérome
authors.initials: J
authors.lastname: Bertherat
authors.forename: Françoise
authors.initials: F
authors.lastname: Borson-Chazot
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.forename: Christine
authors.initials: C
authors.lastname: Cortet-Rudelli
authors.forename: Philippe
authors.initials: P
authors.lastname: Chanson
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*; D000236:Adenoma / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D000328:Adult; D003131:Combined Modality Therapy; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007016:Hypophysectomy; D007231:Infant, Newborn; D010911:Pituitary Neoplasms / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000628:therapy*; D011256:Pregnancy Outcome; D011878:Radiotherapy; D012189:Retrospective Studies