When the Unexpected Happens: A Case of Acromegaly Diagnosed During Pregnancy
Introduction: Pregnancy in a patient with acromegaly is uncommon, as the enlarging pituitary adenoma may compromise the gonadotropin secretion rendering the patient amenorrheic and infertile. About 40% of the women with pituitary adenomas also have hyperprolactinemia, which further decreases the likelihood of pregnancy.
Case Report: A 32-years-old woman was sent to our center in the first trimester of pregnancy with the diagnostic of gestational diabetes. Clinical examination revealed acromegalic features. Her blood pressure was normal.
Hormonal profile showed an elevated growth hormone (80 ng/mL; reference range < 8.0 ng/mL) and insulin-like growth factor 1 (IGF-1) (1442 ng/mL; reference range 101-267 ng/mL). Prolactin was also elevated (38 ng/mL; reference value 1.8-20.0 ng/mL).
No vision or field defects were identified. She underwent a sellar magnetic resonance imaging that showed a pituitary macroadenoma, with left cavernous sinus invasion but without compression of the optic chiasma.
She delivered a full-term baby girl by caesarian section, healthy and without any malformations.
After the delivery, she began octreotide which was later changed to lanreotide and cabergoline. The IGF-1 value remains above the range but there was a regression of her acromegalic features. The last magnetic resonance imaging showed a reduction of the tumor size but the left cavernous sinus invasion persists.
Discussion: Pregnancy in women with acromegaly is uncommon but it can have a normal course, without obstetrical or fetal complications, and treatment can be postponed to the postpartum period.
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