C Căpăþînă1,2, Ş Radian1,2, I Baciu1,2, A Ghinea1, D Deciu1, A Dumitraşcu1, V Ciubotaru3, C Poiană1,2. 1. "C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania. 2. "Carol Davila" University of Medicine and Pharmacy, Dept. of Endocrinology, Bucharest, Romania. 3. "Bagdasar Arseni" Emergency Hospital, Dept. of Neurosurgery, Bucharest, Romania.
Abstract
BACKGROUND: Patients with acromegaly (caused by growth-hormone-secreting pituitary adenomas) are at increased risk of hypopituitarism, in particular hypogonadotropic hypogonadism, before and after multimodal therapy. In affected women of reproductive age, fertility is impaired and complex fertility treatments are needed to achieve conception. CASE PRESENTATION: We present the case of a young woman with acromegaly caused by a GH-secreting macroadenoma with suprasellar and bilateral cavernous sinus extension; hypogonadotropic hypogonadism and secondary hypothyroidism were present from the initial evaluation. Neurosurgical intervention was repeatedly recommended but the patient refused it initially; also she was non-compliant to the medical treatment of acromegaly. Transsphenoidal tumor debulking with adjuvant gamma-knife radiotherapy was eventually performed. Following treatment persistent active acromegaly and hypogonadotropic hypogonadism were diagnosed. Under chronic estroprogestative replacement therapy, the patient conceived and delivered a full-term healthy newborn without any complications. Possible mechanisms are discussed. CONCLUSIONS: Secondary hypogonadotropic hypogonadism in pituitary patients, even when considered permanent (after surgery and radiotherapy), can exceptionally allow spontaneous conception and normal course of pregnancy.
BACKGROUND: Patients with acromegaly (caused by growth-hormone-secreting pituitary adenomas) are at increased risk of hypopituitarism, in particular hypogonadotropic hypogonadism, before and after multimodal therapy. In affected women of reproductive age, fertility is impaired and complex fertility treatments are needed to achieve conception. CASE PRESENTATION: We present the case of a young woman with acromegaly caused by a GH-secreting macroadenoma with suprasellar and bilateral cavernous sinus extension; hypogonadotropic hypogonadism and secondary hypothyroidism were present from the initial evaluation. Neurosurgical intervention was repeatedly recommended but the patient refused it initially; also she was non-compliant to the medical treatment of acromegaly. Transsphenoidal tumor debulking with adjuvant gamma-knife radiotherapy was eventually performed. Following treatment persistent active acromegaly and hypogonadotropic hypogonadism were diagnosed. Under chronic estroprogestative replacement therapy, the patient conceived and delivered a full-term healthy newborn without any complications. Possible mechanisms are discussed. CONCLUSIONS: Secondary hypogonadotropic hypogonadism in pituitary patients, even when considered permanent (after surgery and radiotherapy), can exceptionally allow spontaneous conception and normal course of pregnancy.
Authors: L Katznelson; D Kleinberg; M L Vance; S Stavrou; K J Pulaski; D A Schoenfeld; D L Hayden; M E Wright; C J Woodburn; A Klibanski; S Stravou Journal: Clin Endocrinol (Oxf) Date: 2001-02 Impact factor: 3.478
Authors: Shereen Ezzat; Sylvia L Asa; William T Couldwell; Charles E Barr; William E Dodge; Mary Lee Vance; Ian E McCutcheon Journal: Cancer Date: 2004-08-01 Impact factor: 6.860