Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, 80131 Naples, Italy.
Dipartimento di Scienze Ostetriche, Ginecologiche, Urologiche e Medicina della Riproduzione, Università Federico II di Napoli, 80131 Naples, Italy.
J Clin Endocrinol Metab. 2023 Jul 14;108(8):e583-e593. doi: 10.1210/clinem/dgad042.
Fertility represents a major concern in patients with acromegaly.
The current retrospective study aimed to investigate gonadal function and fertility rates in acromegalic women.
In this referral-center study, 50 acromegalic women with disease onset within reproductive age were evaluated for prevalence of gonadal dysfunction and infertility. Anthropometric, metabolic, hormonal parameters, and gynecological ultrasound were evaluated at diagnosis and after disease control. Data about menstrual disturbances, pregnancy, and polycystic ovarian morphology (PCOM) were investigated at disease onset, at diagnosis, and after disease control.
At presumed disease onset, menstrual disturbances were reported in 32% of patients. Uterine leiomyoma, ovarian cysts, and PCOM were diagnosed in 18%, 12%, and 8%, respectively; 36.8% of patients were infertile. At diagnosis, menstrual disturbances were found in 58.1% (P = .02), being significantly more prevalent in patients with higher insulin-like growth factor-I quartiles (Q) (P = .03, Q1 vs Q4). Gynecological ultrasound revealed uterine leiomyoma, ovarian cysts, and PCOM in 39.1% (P = .04), 28.2% (P = .09), and 13% (P = .55), respectively. The infertility rate was 100% (P = .02). At disease control, menstrual disturbances were slightly decreased as compared to diagnosis (P = .09). Noteworthy, menstrual disturbances (P = .05) and particularly amenorrhea (P = .03) were significantly more frequent in patients with active disease duration greater than 5 years (median) as compared to those achieving disease control in less than 5 years. Among patients with pregnancy desire, 73.3% conceived at least once, with resulting infertility significantly decreased compared to diagnosis (26.7%; P = .01). At-term deliveries, preterm deliveries, and spontaneous abortions were recorded in 86.7%, 6.6%, and 6.6%, respectively, of the 15 pregnancies reported by the patients. No neonatal malformations and/or abnormalities were recorded.
Gonadal dysfunction and infertility are common in acromegalic women within reproductive age, being directly influenced by disease status and/or duration.
生育能力是肢端肥大症患者的主要关注点。
本回顾性研究旨在调查肢端肥大症女性的性腺功能和生育能力。
在这个转诊中心的研究中，评估了 50 名发病年龄在生育期内的肢端肥大症女性的性腺功能障碍和不孕患病率。在诊断时和疾病控制后评估了人体测量学、代谢、激素参数和妇科超声。在疾病发病时、诊断时和疾病控制后调查了月经紊乱、妊娠和多囊卵巢形态（PCOM）的数据。
在假定的疾病发病时，32%的患者报告月经紊乱。诊断时发现子宫肌瘤、卵巢囊肿和 PCOM 分别为 18%、12%和 8%；36.8%的患者不孕。在诊断时，58.1%的患者（P=0.02）发现月经紊乱，在胰岛素样生长因子-I 四分位数（Q）较高的患者中更为常见（P=0.03，Q1 与 Q4）。妇科超声显示子宫肌瘤、卵巢囊肿和 PCOM 分别为 39.1%（P=0.04）、28.2%（P=0.09）和 13%（P=0.55）。不孕率为 100%（P=0.02）。与诊断时相比，疾病控制时月经紊乱略有减少（P=0.09）。值得注意的是，与在 5 年内达到疾病控制的患者相比，疾病持续时间大于 5 年的患者月经紊乱（P=0.05），特别是闭经（P=0.03）更为频繁。在有妊娠愿望的患者中，73.3%至少怀孕一次，与诊断时的不孕率（26.7%）相比显著降低（P=0.01）。报告的 15 例妊娠中，足月分娩、早产和自然流产分别为 86.7%、6.6%和 6.6%。未记录新生儿畸形和/或异常。
在生育期内，肢端肥大症女性的性腺功能障碍和不孕较为常见，直接受疾病状态和/或持续时间的影响。
