Approach of Acromegaly during Pregnancy
Abstract
:1. Introduction
Aim
2. Methods
3. GH-IGF1 Axes during Pregnancy: Non-Acromegalic and Acromegalic Females
4. Sub/Infertility Issues in Acromegaly
5. Cardio-Metabolic Features in Pregnant Females with Acromegaly
6. Somatotropinoma Evolution during Gestation
7. Specific Medical Therapy for Acromegaly during Pregnancy
8. Prolactin, DAs and Pregnancy
9. Pregnancy Outcome and Materno-Fetal Complications
10. Discussion
11. Conclusions
Author Contributions
Funding
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AIP | aryl hydrocarbon receptor-interacting protein |
AMH | anti-Mullerian hormone |
DA | dopamine analogues |
DM | diabetes mellitus |
FSH | Follicle Stimulating Hormone |
GH | Growth Hormone |
GnRH | Gonadotropin Releasing Hormone |
GH-RH | GH Releasing Hormone |
HBP | high blood pressure |
IGF1 | Insulin-like Growth Factor |
IGFBP | IGF Binding Protein |
IQ | intelligence quotient |
LH | Luteinizing Hormone |
SSA | somatostatin analogues |
SSTR | somatostatin receptors |
SERM | selective estrogen receptor modulator |
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First Author/ Year of Publication/ Reference No. | Type of Study | Studied Population | Results |
---|---|---|---|
Das L. 2021 [75] | Retrospective study | N = 14 pregnancies from 12 ACM women N1 = 5 active disease N2 = 9 controlled ACM | 100% had macroadenomas 2 years: median from hypophysectomy to pregnancy confirmation 13/14 term delivery, normal APGAR 1/14 HBP and preterm birth 0%: congenital malformations N1 = N2: materno-fetal outcomes N1 = N2: postpartum GH |
Babinska A. 2021 [127] | Case report | 1 female case with ACM | 1 healthy new born → followed up for 15 years. |
Meoni G. 2020 [95] | Retrospective study | N = 141 pregnancies from 127 ACM women N1 = 67 pregnancies in 62 females + SSAs N2 = 74 pregnancies in 65 females treated+ no SSAs | N1 = N2: materno-fetal outcomes Maternal: DM, HBP, headache, delivery mode) Fetal: birth term, height and weight of the new born 1/14 case of congenital malformation (N1)—ureteral stenosis |
Guarda FJ. 2020 [111] | Case series | N = 4 pregnancies in 3 ACM females (one twin pregnancy) | N = 1 female (2 pregnancies)—exposure to PEG until 3 days before embryo transfer N = 2 females—exposure to PEG until the moment of pregnancy confirmation No materno-fetal outcomes |
Vialon M. 2020 [77] | Retrospective study | N = 14 pregnancies in 11 ACM females | N = 7 (50%) had gestational DM |
Wise-Oringer BK. 2019 [125] | Case report | 1 female with X-linked acrogigantism | Prenatal diagnostic of the same disease as the mother → successful pregnancy |
Hannon AM. 2019 [96] | Case report | 1 female with ACM diagnostic within week 11 | Use of octreotide s.c. 100→150 µg/day to control tumor expansion in order to prevent visual loss (she refused surgery) |
Hannon AM. 2019 [118] | Irish Pituitary Study | N = 17 pregnancies in 12 ACM females | 6/17: DA exposure among pregnancy (SSAs was stopped before gestation) Maternal outcomes: no tumor expansion, no visual field event, no case of gestational DM Fetal outcomes: 15/17: healthy newborns at term 1/17: pre-eclampsia—related emergency cesarean (week 32) 1/17: elective C-section for twin pregnancy (week 35) |
Dicuonzo F. 2019 [97] | Case report | 1 female with giant, inoperable macroadenoma | 1 healthy newborn at term |
Jallad RS. 2018 [78] | Retrospective study | N = 31 pregnancies in 20 ACM females | 4/31 abortion 45%: the rate of HBP worsening 32%: the rate of glucose profile worsening 0%: maternal-fetal death 2/27: congenital malformation 1/27: macrosomia |
Dogansen SC. 2018 [76] | Retrospective study | N = 13 pregnancies in 45 ACM females |
7.7%: the rate of gestational DM and HBP 0%: tumor expansion |
Karaca Z. 2018 [120] | Retrospective study | N = 21 pregnancies in ACM women (a cohort of 113 cases with pituitary tumors) | Congenital malformations: unilateral congenital cataract, craniosynostosis and microcephaly |
Tomczyk K. 2017 [122] | Case report | 1 female with ACM with pre-conception partial hypophysectomy for macroadenoma | 1 healthy newborn at term |
Lambert K. 2017 [121] | Prospective study | N = 3 pregnancies in ACM women (a cohort of 71 cases with pituitary tumors) | No pregnancies outcome: HBP, DM, preterm labor, stillbirth |
Teltayev D. 2917 [102] | Case report | 1 female with ACM | 1 healthy newborn at term |
Căpăþînă C. 2016 [51] | Case report | 1 female with ACM with pre-conception debulking hypophysectomy and gammaknife radiotherapy for macroadenoma | 1 healthy newborn at term |
Viani S. 2016 [124] | Case report | 1 female with ACM | subcutaneous implantable defibrillator for secondary prevention of sudden cardiac death |
Haliloglu O. 2016 [129] | Longitudinal study | N = 16 pregnancies in 6 ACM females | 2/16: large for gestational age 2/16: tall for the age during childhood. |
Hara T. 2016 [128] | Case report | 1 female with ACM | 1 healthy newborn (diagnostic of acromegaly after 1 year of lactation) |
van der Lely AJ. 2015 [109] | ACROSTUDY | N = 35 pregnancies with pegvisomant exposure (27/35 females with ACM) | Data obtained for 10 full-term healthy newborns 5 ACM females: elective abortion 2 ACM females: spontaneous abortion 1 ACM female: ectopic pregnancy |
Dias M. 2013 [39] | Prospective study | N = 10 pregnancies in 8 ACM females Versus N1 = 64 control pregnancies | N = N1: 1 case of HBP/preeclampsia and 1 case of DM |
Koshy TG. 2012 [93] | Case report | 1 female with ACM | Pituitary surgery (week 22) → cabergoline (1 mg/week) → full-term, healthy new born (cesarean) |
Cheng S. 2012 [131] | Case series 343 | N = 13 pregnancies in ACM females | No teratogenic effect |
Kasuki L. 2012 [94] | Case report | 1 female with ACM (pre-conception surgery) | 1 healthy newborn (week 37, cesarean) |
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Popescu, A.D.; Carsote, M.; Valea, A.; Nicola, A.G.; Dascălu, I.T.; Tircă, T.; Abdul-Razzak, J.; Țuculină, M.J. Approach of Acromegaly during Pregnancy. Diagnostics 2022, 12, 2669. https://doi.org/10.3390/diagnostics12112669
Popescu AD, Carsote M, Valea A, Nicola AG, Dascălu IT, Tircă T, Abdul-Razzak J, Țuculină MJ. Approach of Acromegaly during Pregnancy. Diagnostics. 2022; 12(11):2669. https://doi.org/10.3390/diagnostics12112669
Chicago/Turabian StylePopescu, Alexandru Dan, Mara Carsote, Ana Valea, Andreea Gabriela Nicola, Ionela Teodora Dascălu, Tiberiu Tircă, Jaqueline Abdul-Razzak, and Mihaela Jana Țuculină. 2022. "Approach of Acromegaly during Pregnancy" Diagnostics 12, no. 11: 2669. https://doi.org/10.3390/diagnostics12112669