Year: 2024
Type: article
Study design: Case Report
Abstract: Disclosure: S. Chlebek: None. Y.S. Guerra: None. Background: Acromegaly is a rare disease due to excessive GH secretion, usually from a benign pituitary adenoma. Gonadal dysfunction and infertility are common in acromegalic women within reproductive age [1]. Effective treatment typically improves fertility. Minimal data, mostly in the form of isolated cases, is available on pregnancy in acromegaly. Clinical Case: A 39-year-old woman presented to outpatient Endocrinology for management of acromegaly. Past medical history was notable for a GH secreting pituitary adenoma, of unknown size, which was initially found in Mexico during work-up for progressive, chronic headaches and gradual enlargement of her facial features, feet, and hands. The patient subsequently underwent trans-sphenoidal resection of the pituitary adenoma. A post-operative MRI revealed a residual adenoma with a 94% decrease in size. She declined further therapy at that time. The patient reported improvement in her symptoms, however, these gradually recurred over two years. She traveled to the U.S. from Mexico and sought Endocrine evaluation. Clinically, the patient exhibited features of acromegaly: coarse facial features and acanthosis nigricans at the nape. She was found to have biochemical persistence: GH at the upper limit of normal (3.479 ng/mL, normal 0.010-3.607 ng/mL) and IGF-1 elevation (573 ng/mL, normal 53-331 ng/mL). The remainder of the results were unremarkable, and an MRI was scheduled. The patient returned to clinic, 3-months later, 11-weeks pregnant. While pregnant, the MRI Brain revealed a macroadenoma without optic chiasm compression. Furthermore, there were no visual field defects on Ophthalmology evaluation. The patient decided to forego medical therapy for acromegaly during pregnancy. Notably, she was diagnosed with gestational diabetes and preeclampsia. She delivered a healthy baby without complications and with no fetal malformations. Post-partum, the patient was initiated on a somatostatin analog with a plan for repeat biochemical testing at her next appointment. Conclusion: As pregnancy is rare in women with acromegaly, few case reports have been published on this clinical presentation. Pregnancy warrants consideration of adenoma growth and the impact of hormone hypersecretion on the patient and fetus. Failure to achieve biochemical control may increase the risk of gestational diabetes and hypertension, as seen in this patient. Post-partum treatment and regular follow-up are important for managing acromegaly and associated complications. Reference:1.Pirchio et al. Fertility in Acromegaly: A Single-Center Experience of Female Patients During Active Disease and After Disease Remission, The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 8, August 2023, Pages e583–e593, https://doi.org/10.1210/clinem/dgad042 Presentation: 6/2/2024
Source: Journal of the Endocrine Society
Authors: Sylvia Chlebek, Yannis Sergio Guerra
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,418
OpenAlex ID: W4403149348