Uneventful Pregnancy in an Acromegalic Patient Treated with Slow-Release Lanreotide: A Case Report

Ernesto de Menis, Domenico Billeci and Elisabetta Marton

Ospedale Regionale Treviso 31100, Italy Gualberto Gussoni Milano, 20156, Italy

Until recently, pregnancy was considered an unfrequent event in acromegalic females. With the advent of advanced surgical and medical management more affected women will probably get pregnant, as reviewed in the recent paper by Herman-Bonert et al. (1). Now that somatostatin analogues are the drugs of choice in acromegaly, the safety of their use in pregnancy is becoming of concern. We report the first case of an acromegalic patient who became pregnant while being treated with slow-release lanreotide.

The patient had developed oligomenhorrea and progressive enlargement of the hands and feet since the age of 25, after a normal pregnancy. In 1995, when she was 29, she was investigated for suspected acromegaly. Mean basal GH was 28 ng/mL and decreased only to 18 ng/mL during oral glucose tolerance test; insulin-like growth factor (IGF)-I was 1099 ng/mL (normal reference values 150–269 ng/mL).

A pituitary nuclear magnetic resonance image disclosed an intrasellar adenoma 10 mm in diameter, and the patient underwent a selective adenomectomy by transphenoidal route. She was lost at follow-up until December 1996. On that occasion mean basal GH was 10 ng/mL and IGF-I 630 ng/mL, although a pituitary nuclear magnetic resonance image did not reveal any tumor mass. She referred normal menses, the last one on December 23. On December 30 she received slow-release lanreotide, 30 mg i.m., and the same dose was given on January 13 and 27. Thereafter lanreotide was discontinued because she became pregnant. Pregnancy was uncomplicated for both the mother and the fetus, and a normal vaginal delivery took place on September 27. The Apgar score of the newborn was 9 and 10 at 1 and 10 min respectively: her weight was 2950 g, and her length was 49.5 cm. No malformations were observed, and postnatal development is normal.

Pregnancy is considered quite a rare event in acromegalic females because fertility is often reduced (1). Somatostatin analogues actually represent the medical treatment of choice for acromegaly. They may cause resumption of menses and ovulation in acromegalics by lowering GH and IGF-I levels, by causing shrinkage of the tumor, and perhaps also due to an opiate antagonistic action (2), but this effect was not confirmed in humans (3). Apart from their influence on fertility, the safety of somatostatin analogues in pregnancy is of concern, for somatostatin receptors are expressed during fetal life (4). Toxicological studies have shown that octreotide and lanreotide do not cause malformations and have no significant effects on prenatal and postnatal development at conventional doses (5, 6). Experience in humans is limited also because patients are advised to avoid pregnancy during treatment with somatostatin analogues. Octreotide passes the placenta, and its concentration in umbilical-cord serum was 359 ng/mL in a newborn whose mother was being treated for a TSH-secreting adenoma (7). To our knowledge, seven acromegalic patients received octreotide during their pregnancy (1, 8, 9, 10, 11); in all but two cases octreotide was stopped early during pregnancy. All newborns showed no malformations and normal postnatal development.

Lanreotide is a synthetic somatostatin analogue, and a slow-release formulation proved effective in the treatment of acromegaly and may increase the compliance of patients (12). On the other hand, with the slow-release formulation, the fetus is exposed to the somatostatin analogue for a longer time, even after drug suppression because of pregnancy.

We report the first case of an acromegalic patient treated with slow-release lanreotide during pregnancy. The drug was discontinued as soon as the patient was found to be pregnant, but the embryo had been exposed to lanreotide for at least one month. The pregnancy was uneventful; the fetal development was normal, the newborn in good health, and the postnatal growth regular.

In conclusion, despite quite reassuring preliminary reports, it seems safest to discontinue somatostatin analogues during pregnancy until more data are obtained. Furthermore many women in the fertile age should receive adequate contraception if treated with somatostatin analogues, as these drugs may induce resumption of menses and may improve fertility.

Footnotes

Address correspondence to: Ernesto De Menis, M.D., I Divisione Medica, Ospedale Regionale, 31100 Treviso, Italy.

Received November 5, 1998.

References

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