Serdal KORKMAZ, Hatice Sebila DÖKMETAŞ, Fatih KILIÇLI, Fahrettin MUR KELEŞT

A successful pregnancy in a patient with acromegaly under octreotide-LAR treatment: A case report

Hipofizer makroadenom nedeniyle opere olan 30 yaşındaki bayan hastanın operasyon sonrası yapılan oral glukoz testine GH cevabı yetersizdi. Bu nedenle Octreotide-LAR (OCT-LAR) tedavisi başlandı. Tedavinin 15. Ayında, 4 aydan beri adet görmemesi nedeniyle yapılan gebelik testinde gebelik olduğu tespit edildi. Hasta bu dönemde gebe olduğunu bilmediği için OCT-LAR tedavisi almıştı. Hipofiz manyetik rezonans görüntülemede (MRG) adenomda büyüme olmadığı görüldüğü için OCT-LAR tedavisi kesildi. Hasta gebeliğin 37. haftasında 50 cm boyunda ve 2650 gr ağırlığında sağlıklı bir kız doğurdu. Postpartum dönemde adenoma değerlendirmek için yapılan hipofiz MRG’de büyüme olmadığı görüldü. Doğumdan 2 ay sonra yapılan OGTT’ye büyüme hormon supresyonu yetersiz olduğu için OCT-LAR tedavisi yeniden başlandı. Akromegali hastalarında gebelik oluştuğunda tedaviye devam etme veya bırakma kararını vermek için adenoma boyutunun hipofiz MRG ile kontrol edilmesi gerektiğinin en uygun yaklaşım olduğuna inanıyoruz. Ayrıca daha güvenli veriler elde edilinceye kadar gebelik sırasında OCT-LAR tedavisi kesilmesi gerektiğini düşünüyoruz.

Oktreotid-LAR tedavisi alan akromegalik bir hastada başarılı gebelik: Olgu sunumu

The patient was a 30 -year-old female acromegaly patient who was operated for pituitary macroadenoma. The response to postoperative oral glucose tolerance test (OGTT) after operation was insufficient. For this reason, Octreotide-LAR (OCT-LAR) treatment was started. On 15 months after the therapy, the patient presented with failure of menstruation for four months, so pregnancy test was performed and pregnancy was diagnosed. The patient had used OCT-LAR during the period without knowing that she was pregnant. Since it has been shown with magnetic resonance imaging (MRI) that the pituitary adenoma did not grow, we stopped the OCT-LAR treatment. The patient delivered a healthy newborn girl of 2650 g in weight and 50 cm in length at the 37 weeks of gestation. MRI was performed for postpartum macroadenoma assessment and the lesion did not grow during this period. Two months after the delivery, the response of growth hormone to OGTT was evaluated. OCT LAR treatment was started again because the suppression was not seen. We believe that the size of the adenoma must be checked by MRI to make a decision in discontinuing or continuing treatment as the most suitable approach, when pregnancy develops in acromegalic patients. Furthermore, we think that OCT-LAR should be discontinued during pregnancy until more safety data are obtained.

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