J Korean Endocr Soc.  2010 Mar;25(1):56-60. 10.3803/jkes.2010.25.1.56.

Acromegaly with Diabetes Insipidus after Pituitary Tumor Removal: Successful Pregnancy and Delivery

• Kim SH
• Kim JI
• Park YM
• Won IS
• Shin KC
• Jo Y
• Lee S
• Kim YS
• Lee KY
• Park IB

• KMID: 2177862
• DOI: http://doi.org/10.3803/jkes.2010.25.1.56

Abstract

A 33-year-old woman visited our hospital because of oligomenorrhea. Acromegaly was diagnosed based on elevated insulin like growth factor-I (IGF-I) and paradoxical growth hormone (GH) rise in oral glucose tolerance test. Pituitary macroadenoma was detected on magnetic resonance imaging (MRI). The pituitary tumor was removed. Still, diabetes insipidus developed. We prescribed desmopressin and bromocriptine. Two months post-surgery, IGF-I was decreased and a combined pituitary function test was normal, except for the follicle stimulating hormone response. Residual tumor was detected on MRI. The bromocriptine dose was increased and treatment with the long-acting somatostatin analogue octreotide long acting release (LAR) was begun. After the fifth round of octreotide LAR, IGF-I was normalized. After the seventh round of octreotide LAR, the patient became pregnant. Bromocriptine and octreotide LAR were stopped, and desmopressin was continued. Successful delivery occurred at week 38 of pregnancy. The patient was discharged without any complications. Acromegaly is a disease caused by chronic GH hypersecretion, generally related to a somatotroph adenoma. Amenorrhea and menstrual irregularities are common in acromegaly. Pregnancy rarely occurs because chronic anovulation usually exists. When gonadotroph axis was preserved, the possibility of pregnancy in a woman of child-bearing age with acromegaly should be considered.

Keyword

Acromegaly; Octreotide; Pregnancy

MeSH Terms

Acromegaly
Adult
Amenorrhea
Anovulation
Axis, Cervical Vertebra
Bromocriptine
Deamino Arginine Vasopressin
Diabetes Insipidus
Female
Follicle Stimulating Hormone
Glucose Tolerance Test
Gonadotrophs
Growth Hormone
Growth Hormone-Secreting Pituitary Adenoma
Humans
Insulin
Insulin-Like Growth Factor I
Magnetic Resonance Imaging
Neoplasm, Residual
Octreotide
Oligomenorrhea
Pituitary Function Tests
Pituitary Neoplasms
Pregnancy
Somatostatin
Bromocriptine
Deamino Arginine Vasopressin
Follicle Stimulating Hormone
Growth Hormone
Insulin
Insulin-Like Growth Factor I
Octreotide
Somatostatin

Figure

• 

  Fig. 1 Sella MRI showed pituitary adenoma. A. About 1.8 × 1.5 cm sized solid and cystic tumor was seen at the time of diagnosis. B. About 1 cm sized residual tumor was seen at right portion of pituitary gland after trans-sphenoidal pituitary tumor removal. C. Decreased residual pituitary adenoma (6 mm sized) with necrotic portion was seen after delivery.

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