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Uncontrolled acromegaly increases complication risks during pregnancy
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Pregnant women with acromegaly are more likely to experience diabetic and hypertensive complications during gestation vs. women without acromegaly, particularly when the disease is uncontrolled, according to findings from a small retrospective study published in Clinical Endocrinology.
“The improvement in acromegaly and fertility treatments has provided an increase in pregnancies prevalence in acromegaly, thus highlighting the need for planned pregnancy to minimize the potential risks of worsening acromegaly and its comorbidities,” Raquel Soares Jallad, MD, of the neuroendocrine unit at Hospital de Clinicas and the University of Sao Paulo Medical School, Brazil, and colleagues wrote. “It is important to control [growth hormone/insulin-like growth factor I] hypersecretion and tumor volume before considering pregnancy.”
Jallad and colleagues analyzed medical records from 31 pregnancies in 20 women with diagnosed acromegaly before pregnancy from three tertiary referral pituitary centers in Brazil and Israel (mean age at start of pregnancy, 32 years; mean time between acromegaly diagnosis and pregnancy, 58.6 months). All included pregnancies were spontaneous and occurred without reproductive treatment. Data included pretreatment demographic and disease profile information and treatment prescribed during pregnancy and after delivery. During pregnancy follow-up, women were instructed to report symptoms and signs related to acromegaly and potential comorbidities.
Within the cohort, 14 women underwent transsphenoidal surgery as primary acromegaly treatment before pregnancy; six did not receive treatment and were uncontrolled. Of the 31 pregnancies, 27 resulted in live birth (one birth of twins), with 16 born by cesarean section. Pre-existing comorbidities at diagnosis included hypothyroidism (10%), glucose intolerance (25%), diabetes (15%) and hypertension (30%). Eight women reported irregular menses and four reported amenorrhea. One patient developed diabetes during pregnancy. In four pregnancies, IGF-I levels remained elevated throughout pregnancy, whereas IGF-I levels normalized for 23 women. In 13 of 15 pregnancies without medical or surgical treatment, gestational IGF-I levels normalized, according to researchers. After delivery, researchers observed an elevated IGF-I level in most women.
Researchers found that arterial hypertension (45%) and impaired glucose tolerance (32%) were the most common complications during pregnancies. There were no maternal of neonatal deaths.
“Despite major advances in clinical management, we are still facing a higher incidence of diabetic and hypertensive complications compared with the non-acromegalic population,” the researchers wrote. “Therefore, all patients should be evaluated for the risk of worsening glycemic and blood pressure control during gestation. Lactation may be allowed in patients with small tumor remnants.” – by Regina Schaffer
Disclosures : The authors report no relevant financial disclosures.
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