Pregnancy and acromegaly: a review.

Area of Science:

• Reproductive Endocrinology
• Endocrinology
• Obstetrics

Background:

• Acromegaly diagnosis and management during pregnancy present unique challenges.
• Physiologic changes in pregnancy can interfere with accurate diagnosis of acromegaly.
• Placental growth hormone (GH) secretion complicates distinguishing pituitary GH.

Purpose of the Study:

• To review existing literature on diagnosing and managing acromegaly in pregnant individuals.
• To assess the safety and efficacy of treatments for acromegaly during gestation.
• To evaluate the impact of acromegaly on pregnancy and neonatal outcomes.

Main Methods:

• Systematic literature search using MEDLINE and reference list hand-searching.
• Analysis of studies focusing on acromegaly diagnosis and treatment during pregnancy.
• Review of reported outcomes for both mother and fetus.

Main Results:

• Diagnosis is challenging due to overlapping GH and IGF-1 physiology.
• Tumor size progression and metabolic complications are uncommon during pregnancy.
• Neonatal outcomes are generally unaffected, with stable maternal IGF-1 levels observed.
• Pharmacological treatments (dopamine agonists, somatostatin analogues) and GH receptor antagonists appear safe.
• Surgical intervention can often be postponed until postpartum.

Conclusions:

• Pregnancy in acromegaly patients is typically uneventful with positive neonatal outcomes.
• Current evidence suggests safety for dopamine agonists and somatostatin analogues in pregnancy.
• Further research is required to definitively establish the long-term fetal safety of these treatments.