title: [Acromegaly and pregnancy: report of six new cases].
abstract: BACKGROUND
  Pregnancies in acromegalic women are rare. Data from the literature indicate absence of congenital malformation in newborns, an increase of pituitary adenoma volume rarely clinically symptomatic, an increased risk of gestational diabetes and gravid hypertension in women with non-controlled GH/IGF-1 hypersecretion before gestation. The changes of somatotroph function are rarely described.
  
  
  OBJECTIVE
  Report of six new pregnancies in five women with acromegaly.
  
  
  METHODS
  Before pregnancy three women had incomplete surgical resection of GH-secreting pituitary adenoma, all were treated with somatostatin analogues, and the medical treatment was withdrawal at the diagnosis of gestation. We studied clinical (blood pressure, headaches, visual field), biological (blood glucose concentration) signs, GH and IGF-1 levels were measured during each trimester of pregnancy as well as in post-partum and were compared with pregestational values, MRI of the pituitary performed during the second trimester and in the post-partum were compared with MRI examen before pregnancy.
  
  
  RESULTS
  All those pregnancies were normal without gestational diabetes, gravid hypertension and pituitary tumor syndrome. Clinical signs of acromegaly improved in 50 % of the patients, and IGF-1 decreased (22 %) in comparison of pregestational value without significant change in GH levels. No newborn had congenital malformation.
  
  
  CONCLUSIONS
  Pregnancies in those women with acromegaly are uneventful without obstetrical or foetal complication, but a maternal follow-up is necessary in order to diagnose gravid hypertension and gestational diabetes. On the other hand, a clinical monitoring of pituitary tumor syndrome is necessary in women with non-operated GH-secreting macroadenoma before pregnancy. During the first trimester of gestation, an improvement of acromegalic signs can be due to a decrease of IGF-1 levels related to hepatic GH-resistance state secondary to physiological secretion of estrogens during gestation.
authors.affiliation: Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Persechini
authors.affiliation: Laboratoire de biochimie, institut fédératif de biologie, CHU Purpan, 330, avenue de Grande-Bretagne, TSA 40031, 31059 Toulouse cedex 9, France.
authors.forename: I
authors.initials: I
authors.lastname: Gennero
authors.affiliation: Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
authors.forename: S
authors.initials: S
authors.lastname: Grunenwald
authors.affiliation: Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
authors.forename: D
authors.initials: D
authors.lastname: Vezzosi
authors.affiliation: Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Bennet
authors.affiliation: Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France. Electronic address: caron.p@chu-toulouse.fr.
authors.forename: P
authors.initials: P
authors.lastname: Caron
mesh_terms: D000172:Acromegaly / Q000150:complications*; D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000209:etiology; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I
keywords: Acromegaly; Acromégalie; Analogues de la somatostatine; Congenital malformation; Diabète gestationnel; GH; Gestational diabetes; Gravid hypertension; Grossesse; Hypertension gravidique; IGF-1; Malformation congénitale; Pituitary tumoral syndrome; Pregnancy; Somatostatin analogs; Syndrome tumoral; Traitement; Treatment