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.

中文翻译：

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接受肢端肥大症治疗的女性的妊娠过程和结局：辨别当代队列

客观的

分析接受肢端肥大症治疗的女性的妊娠过程和结局，并根据受孕时的疾病活动比较结局。

设计

回顾性研究。

耐心

2010 年至 2019 年在怀孕前或怀孕期间诊断出患有肢端肥大症的女性，代表病例（12 例中 14 次怀孕），后来根据受孕时的活动性（n  = 5）或受控疾病（n  = 9）进行分层。同期女性肢端肥大症患者构成“肢端肥大症队列”（AC）（n  = 75）。

结果

所有病例均有大腺瘤，最低GH为15.06 ng/ml（IQR 9-30），IGF-I指数为3.04（1.96-3.82），均接受垂体手术；除了在怀孕期间确诊的两名患者，她们在产后 4 个月接受了药物治疗和手术。71.4% 的患者需要辅助药物治疗，35.7% 的患者需要放疗。怀孕发生在手术后 2（0.8-5.1）年的中位数，21.4% 需要辅助生殖。除了 1 例患有妊娠期高血压的早产儿外，所有患者均在 APGAR 正常的情况下足月分娩。没有人有先天性畸形。尽管孕前活动性肢端肥大症患者的基线 IGF-I、GH 和肿瘤体积较高，但母胎结局与受控疾病患者没有差异（p > 0.05)。相似或更高比例的病例具有正常的生长激素，产后没有残留肿瘤，即使在那些患有孕前活动性肢端肥大症的病例中也是如此。

结论

目前的研究表明，接受肢端肥大症治疗的女性妊娠结局良好，并且在相同人群中妊娠参数或并发症的发生率不高于非肢端肥大症妊娠。活动性肢端肥大症似乎对结果没有不利影响。