Acromegalia e gravidanza: gestione clinica

Acromegaly is frequently associated with reduced fertility in affected women, due to several factors including the average age at diagnosis, hyperprolactinaemia, hypogonadotropic hypogonadism and the direct effect of an excess of Growth Hormon/Insulin-like Growth Factor 1 (GH/IGF-1) on the hypothalamic gonadotropin-releasing hormone (GnRH) and on the ovary. Despite this, in recent years the number of pregnancies occurring in these women has increased, thanks to greater effectiveness of the treatments available, allowing the achievement of good disease control, and thanks to the use of medically-assisted reproduction techniques. Consequently, knowledge regarding risks potentially associated with this condition is also increasing. Pregnancy in acromegalic women generally has a normal course without complications for mother and foetus; however, it must be planned and managed adequately. In this particular review, we examine the effects of pregnancy on tumour size and GH and IGF-1 levels, the effects of GH suppressive drugs on the foetus and the impact of cardiovascular and metabolic comorbidities that are associated with active disease; a management model is also proposed in light of the literature evidence.