Liza Das , Pinaki Dutta , Balamurugan Thirunavukkarasu , Kirti Gupta , Manjul Tripathi , Prakamya Gupta , Neelam Aggarwal , Ashutosh Rai , Bishan Dass Radotra , Anil Bhansali , Vanita Suri
{"title":"Course and outcomes of pregnancy in women treated for acromegaly: Discerning a contemporary cohort","authors":"Liza Das , Pinaki Dutta , Balamurugan Thirunavukkarasu , Kirti Gupta , Manjul Tripathi , Prakamya Gupta , Neelam Aggarwal , Ashutosh Rai , Bishan Dass Radotra , Anil Bhansali , Vanita Suri","doi":"10.1016/j.ghir.2021.101417","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To analyze pregnancy course and outcomes in women treated for acromegaly and compare outcomes based on disease activity at the time of conception.</p></div><div><h3>Design</h3><p>Retrospective study.</p></div><div><h3>Patients</h3><p>Women with acromegaly diagnosed prior to or during pregnancy from 2010 to 2019, representing cases (14 pregnancies in 12 cases), were later stratified based on active (<em>n</em> = 5) or controlled disease (<em>n</em> = 9) at time of conception. Female acromegalic patients over the same period constituted the ‘acromegaly cohort’ (AC) (<em>n</em> = 75).</p></div><div><h3>Results</h3><p><span><span>All cases had macroadenomas with nadir GH of 15.06 ng/ml (IQR 9–30), IGF-I index of 3.04 (1.96–3.82), for which they had undergone </span>pituitary surgery<span>; except two patients diagnosed during pregnancy, who received pharmacotherapy followed by surgery 4 months postpartum. Adjuvant pharmacotherapy was required in 71.4% patients and radiotherapy in 35.7%. Pregnancy occurred at a median of 2 (0.8–5.1) years after surgery and 21.4% required assisted reproduction<span>. All had term delivery with normal APGAR except one case with gestational hypertension<span>, who delivered a preterm baby. None had congenital malformations. Despite higher baseline IGF-I, GH and tumor volume in those with pre-conceptional active acromegaly, materno-fetal outcomes were not different from those with controlled disease (</span></span></span></span><em>p</em> > 0.05). Similar or greater proportion of cases had normal GH and no residual tumor postpartum, even in those with pre-conceptional active acromegaly.</p></div><div><h3>Conclusion</h3><p>The current study showed conducive outcomes of gestation in women treated for acromegaly and no higher rates of pregnancy parameters or complications than non-acromegaly pregnancies in the same population. Active acromegaly does not seem to have an adverse bearing on outcomes.</p></div>","PeriodicalId":12803,"journal":{"name":"Growth Hormone & Igf Research","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ghir.2021.101417","citationCount":"3","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Growth Hormone & Igf Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S109663742100040X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CELL BIOLOGY","Score":null,"Total":0}
引用次数: 3
Abstract
Objective
To analyze pregnancy course and outcomes in women treated for acromegaly and compare outcomes based on disease activity at the time of conception.
Design
Retrospective study.
Patients
Women with acromegaly diagnosed prior to or during pregnancy from 2010 to 2019, representing cases (14 pregnancies in 12 cases), were later stratified based on active (n = 5) or controlled disease (n = 9) at time of conception. Female acromegalic patients over the same period constituted the ‘acromegaly cohort’ (AC) (n = 75).
Results
All cases had macroadenomas with nadir GH of 15.06 ng/ml (IQR 9–30), IGF-I index of 3.04 (1.96–3.82), for which they had undergone pituitary surgery; except two patients diagnosed during pregnancy, who received pharmacotherapy followed by surgery 4 months postpartum. Adjuvant pharmacotherapy was required in 71.4% patients and radiotherapy in 35.7%. Pregnancy occurred at a median of 2 (0.8–5.1) years after surgery and 21.4% required assisted reproduction. All had term delivery with normal APGAR except one case with gestational hypertension, who delivered a preterm baby. None had congenital malformations. Despite higher baseline IGF-I, GH and tumor volume in those with pre-conceptional active acromegaly, materno-fetal outcomes were not different from those with controlled disease (p > 0.05). Similar or greater proportion of cases had normal GH and no residual tumor postpartum, even in those with pre-conceptional active acromegaly.
Conclusion
The current study showed conducive outcomes of gestation in women treated for acromegaly and no higher rates of pregnancy parameters or complications than non-acromegaly pregnancies in the same population. Active acromegaly does not seem to have an adverse bearing on outcomes.
期刊介绍:
Growth Hormone & IGF Research is a forum for research on the regulation of growth and metabolism in humans, animals, tissues and cells. It publishes articles on all aspects of growth-promoting and growth-inhibiting hormones and factors, with particular emphasis on insulin-like growth factors (IGFs) and growth hormone. This reflects the increasing importance of growth hormone and IGFs in clinical medicine and in the treatment of diseases.