Acromegaly and pregnancy- a doctor’s perspective

Because acromegaly is diagnosed today at an earlier age than in the past, concerns with pregnancy do occur. It has been found that acromegaly may decrease the fertility of a woman, and in the case of infertility, medical intervention can help.

During pregnancy, women without acromegaly typically have an increased production of growth hormone (GH), IGF-1, and GH-releasing hormones. These hormones play an important role in the normal growth and function of the placenta. The excessive production of these hormones during a healthy pregnancy may result in the woman becoming puffy in an acromegalic-type manner, especially during the third trimester. Although these women show acromegaly-like changes during their pregnancy, they’re usually resolved after delivery.

Because these hormones are made excessively during a healthy pregnancy, it’s almost impossible to diagnose acromegaly for the first time in a pregnant woman. For this reason, it is best to wait until after delivery to make a diagnosis of acromegaly. If acromegaly is present before pregnancy, it usually has little effect on the course of the pregnancy; the excess GH and IGF-1 do not cross over to the fetus.

Acromegaly has an increased risk of diabetes, as does pregnancy. Thus, there may be an increased risk of gestational diabetes. Acromegaly may also result in some heart problems, so if the patient has pre-existing heart disease, the pregnancy may aggravate these symptoms. Otherwise, pregnancy for a woman with acromegaly is usually not that different from a woman without the condition.

Acromegaly is a chronic disease and pregnancy itself usually has little effect on the long-term course and outcome of acromegaly. The medications used to control acromegaly before pregnancy can usually cease for the duration of the pregnancy and lactation. Generally, the pituitary tumour size is unchanged throughout pregnancy. If symptoms of tumour growth do occur during pregnancy, or tumour growth is a concern, medication may be continued or reintroduced to control this problem. Rarely is surgery necessary.

Because acromegaly usually does not worsen with pregnancy, it is best not to use medications during the pregnancy or the nursing stages, unless necessary. If medication is necessary, there have been no known problems to arise in the mother, baby or course of the pregnancy. Although this is encouraging, experience is very limited and before confidence can be placed in the safety of these medications during pregnancy, more evidence needs to be provided. Patients should discuss their options with a healthcare professional.

Acromegaly symptoms may actually improve during pregnancy. This is because the increased estrogen made during the pregnancy may antagonize the GH/IGF-1 and make them less effective. Paradoxically, a woman without acromegaly may develop acromegaly-like symptoms that are usually reversible.

To summarize, women with acromegaly can generally conceive, with or without medical help, and most often than not, will have a healthy pregnancy. Medications used to control acromegaly can usually cease until after delivery or weaning, without any significant concerns, in the short or long-term.

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Check out the true-2-me guest editorial on treatment Considerations for Acromegaly

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