When a patient with acromegaly becomes pregnant, the clinical picture shifts considerably. Concerns centre on the potential for the pregnancy to stimulate pituitary tumor growth, the ongoing effects of GH excess on the mother, and the safety profile of medications ordinarily used to manage acromegaly.
Pregnancy introduces competing priorities: maintaining adequate control of the underlying pituitary tumor while minimising pharmacological exposure. This scenario — acromegaly in a pregnant patient — calls for a management approach that differs substantially from standard acromegaly care.
The general strategy involves a conservative, selective use of medical therapy during pregnancy. Routine pharmacological treatment is not continued as standard; instead, therapy is reserved for specific circumstances when clinical monitoring indicates a need to act. The full structured protocol defines the precise indications and the agents that may be considered.
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.
During pregnancy, we recommend that acromegaly medical therapy be withheld and administered only for tumor and headache control.
Medical therapy should be considered in the setting of worsening headaches and/or evidence of tumor growth.
Therefore, patients with acromegaly with macroadenomas should be monitored clinically for headaches and visual symptoms.
View source ↗