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[Pregnancy in active acromegaly].

HISTORY AND CLINICAL FINDINGS
A 29-year-old woman with a long-lasting history of oligoamenorrhea, fell pregnant shortly after being diagnosed with acromegaly. LABORATORY TESTS AND IMAGING: A high IGF-1 concentration and an oral glucose tolerance test confirmed the diagnosis. Cranial magnetic resonance imaging demonstrated a macroadenoma of the pituitary with suprasellar extension and compression of the optic chiasm leading to incomplete hemianopsia.


TREATMENT AND COURSE
Transsphenoidal surgery was performed during the second trimester, impaired visual fields became normal and subsequent biochemical tests suggested remission. She delivered a healthy full-term infant via cesarean section after an uncomplicated pregnancy. The infant's development was unremarkable. Postpartum assessment showed persistent acromegaly activity and the patient was judged to require secondary multimodal therapy.


CONCLUSIONS
Pituitary adenomas often cause oligoamenorrhea and may interfere with fertility. Although pregnancy rarely occurs during the course of active acromegaly, the maternal morbidity, including hypertension and gestational diabetes, is increased. While pregnancy may cause an increase in tumor size, biochemical improvement in acromegaly is--as illustrated by the present case--also possible. A maternal-to-fetal transfer of growth hormone or IGF-1 has not been proved.