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Acromegaly and pregnancy: a prospective study.

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Pregnancy in acromegaly patients is safe, with no tumor growth observed and improved disease control after stopping medication. However, uncontrolled acromegaly before pregnancy increases risks for diabetes and hypertension.

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Oncology

Background:

  • Acromegaly, a condition caused by excess growth hormone, presents unique challenges during pregnancy.
  • Previous studies on pregnancy and acromegaly have been limited to retrospective data.

Purpose of the Study:

  • To prospectively evaluate the effects of pregnancy on acromegaly.
  • To assess tumor behavior and disease control in acromegalic patients during and after pregnancy.

Main Methods:

  • A prospective, interventional, multicentric study included eight acromegalic patients with ten pregnancies.
  • Patients had active acromegaly before pregnancy, with pharmacological treatments withdrawn upon diagnosis.
  • Sellar MRI, growth hormone (GH), and insulin-like growth factor 1 (IGF1) levels were monitored.

Main Results:

  • No instances of tumor growth were observed during pregnancy.
  • All ten pregnancies resulted in healthy newborns, with nine deliveries at term.
  • While IGF1 levels were similar during pregnancy, they increased significantly postpartum. The prevalence of controlled IGF1 levels improved throughout gestation.
  • One patient developed diabetes mellitus, and another developed hypertension/preeclampsia, with a non-significant association to pre-pregnancy IGF1 levels.

Conclusions:

  • Pregnancy in acromegalic patients generally leads to improved disease control without stimulating tumor growth, even after discontinuing medication.
  • Discontinuation of drug treatment is feasible for most acromegalic patients during pregnancy.
  • Pre-existing uncontrolled acromegaly may elevate the risk of developing diabetes and hypertension during pregnancy.