Persechini M-L, Gennero I, Grunenwald S, Vezzosi D, Bennet A, Caron P
Service d'endocrinologie-maladies métaboliques-nutrition, pôle cardiovasculaire et métabolique, CHU de Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
Laboratoire de biochimie, institut fédératif de biologie, CHU Purpan, 330, avenue de Grande-Bretagne, TSA 40031, 31059 Toulouse cedex 9, France.
J Gynecol Obstet Biol Reprod (Paris). 2014 Nov;43(9):704-12. doi: 10.1016/j.jgyn.2013.04.008. Epub 2013 Sep 10.
Pregnancies in acromegalic women are rare. Data from the literature indicate absence of congenital malformation in newborns, an increase of pituitary adenoma volume rarely clinically symptomatic, an increased risk of gestational diabetes and gravid hypertension in women with non-controlled GH/IGF-1 hypersecretion before gestation. The changes of somatotroph function are rarely described.
Report of six new pregnancies in five women with acromegaly.
Before pregnancy three women had incomplete surgical resection of GH-secreting pituitary adenoma, all were treated with somatostatin analogues, and the medical treatment was withdrawal at the diagnosis of gestation. We studied clinical (blood pressure, headaches, visual field), biological (blood glucose concentration) signs, GH and IGF-1 levels were measured during each trimester of pregnancy as well as in post-partum and were compared with pregestational values, MRI of the pituitary performed during the second trimester and in the post-partum were compared with MRI examen before pregnancy.
All those pregnancies were normal without gestational diabetes, gravid hypertension and pituitary tumor syndrome. Clinical signs of acromegaly improved in 50 % of the patients, and IGF-1 decreased (22 %) in comparison of pregestational value without significant change in GH levels. No newborn had congenital malformation.
Pregnancies in those women with acromegaly are uneventful without obstetrical or foetal complication, but a maternal follow-up is necessary in order to diagnose gravid hypertension and gestational diabetes. On the other hand, a clinical monitoring of pituitary tumor syndrome is necessary in women with non-operated GH-secreting macroadenoma before pregnancy. During the first trimester of gestation, an improvement of acromegalic signs can be due to a decrease of IGF-1 levels related to hepatic GH-resistance state secondary to physiological secretion of estrogens during gestation.
肢端肥大症女性怀孕的情况较为罕见。文献数据表明，新生儿无先天性畸形，垂体腺瘤体积增加但临床上很少有症状，妊娠前生长激素（GH）/胰岛素样生长因子-1（IGF-1）分泌未得到控制的女性患妊娠期糖尿病和妊娠高血压的风险增加。关于生长激素细胞功能变化的描述很少。
报告5例肢端肥大症女性的6次新妊娠情况。
妊娠前，3名女性的分泌生长激素的垂体腺瘤手术切除不完全，均接受了生长抑素类似物治疗，妊娠诊断时停用药物治疗。我们研究了临床指标（血压、头痛、视野）、生物学指标（血糖浓度），在妊娠各期以及产后测量了生长激素和胰岛素样生长因子-1水平，并与妊娠前的值进行比较，将妊娠中期和产后进行的垂体磁共振成像（MRI）与妊娠前的MRI检查结果进行比较。
所有这些妊娠均正常，无妊娠期糖尿病、妊娠高血压和垂体肿瘤综合征。50%的患者肢端肥大症的临床症状有所改善，与妊娠前相比，胰岛素样生长因子-1水平下降（22%），而生长激素水平无显著变化。没有新生儿出现先天性畸形。
这些肢端肥大症女性的妊娠过程顺利，无产科或胎儿并发症，但需要对母亲进行随访，以便诊断妊娠高血压和妊娠期糖尿病。另一方面，对于妊娠前未手术的分泌生长激素的大腺瘤女性，有必要对垂体肿瘤综合征进行临床监测。在妊娠的前三个月，肢端肥大症症状的改善可能是由于妊娠期间雌激素生理性分泌导致肝脏生长激素抵抗状态，从而使胰岛素样生长因子-1水平降低。
