When a patient with acromegaly plans to become pregnant, standard medical management must be reconsidered. Pregnancy introduces specific concerns that require a structured, pre-conception approach distinct from routine acromegaly care.
Pregnancy in a patient with acromegaly raises concerns on multiple fronts: a possible stimulatory effect of pregnancy on somatotroph tumor size, the ongoing impact of GH excess on the mother, and the safety of medications routinely used to manage acromegaly in this setting.
The evidence-based approach centers on a planned transition in somatostatin receptor ligand (SRL) therapy before conception is attempted. Specific adjustments to the patient's acromegaly medication regimen are required in advance — the complete sequence and alternatives are available in the full protocol.
DOI: 10.1210/jc.2014-2700
For the patient with acromegaly who becomes pregnant, there is a concern for a possible stimulatory effect of the pregnancy on somatotroph tumor size, the effects of GH excess on the mother, and the safety of medications used to treat acromegaly.
We suggest discontinuing long-acting SRL formulations and pegvisomant approximately 2 months before attempts to conceive, with use of short-acting octreotide as necessary until conception.
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