Context: Fertility represents a major concern in patients with acromegaly. Objective: Investigation of gonadal function and fertility rate in acromegalic women. Design: Retrospective study. Anthropometric, metabolic, hormonal parameters, and gynaecological ultrasound were evaluated at diagnosis and after disease control. Data about menstrual disturbances, pregnancy, and PCO-morphology (PCOM) were investigated at disease onset, diagnosis and after disease control. Setting: Referral center. Patients: 50 acromegalic women with disease onset within the reproductive age. Intervention: None. Main outcome measures: Prevalence of gonadal dysfunction and infertility. Results: At presumed disease onset, menstrual disturbances were reported in 32% of patients. Uterine leiomyoma, ovarian cysts and PCOM were diagnosed in 18%, 12% and 8%, respectively; 36.8% of patients were infertile. At diagnosis, menstrual disturbances were found in 58.1% (p = 0.02), being significantly more prevalent in patients with higher IGF-I quartiles (Q) (p = 0.03, Q1 vs Q4). Gynaecological ultrasound revealed uterine leiomyoma, ovarian cysts and PCOM in 39.1% (p = 0.04), 28.2% (p = 0.09), and 13% (p = 0.55), respectively. The infertility rate was 100% (p = 0.02). At disease control, menstrual disturbances (p = 0.05), particularly amenorrhea (p = 0.03), significantly persisted in patients with disease duration above than in those with disease duration below 5 years (median). Among patients with pregnancy desire, 73.3% conceived at least once, resulting infertility significantly decreased compared to diagnosis (26.7%, p = 0.01). At-term, pre-term deliveries and spontaneous abortions were recorded in 86.7%, 3.3% and 10%, respectively. No neonatal malformations and/or abnormalities were recorded. Conclusions: Gonadal dysfunction and infertility are common in acromegalic women within the reproductive age, being directly influenced by the disease status and/or duration.
Fertility in Acromegaly: a single center experience on female patients during active disease and after disease remission / Pirchio, Rosa; Auriemma, Renata S; Grasso, Ludovica F S; Verde, Nunzia; Garifalos, Francesco; Castoro, Michele; Conforti, Alessandro; Menafra, Davide; Pivonello, Claudia; de Angelis, Cristina; Minnetti, Marianna; Alviggi, Carlo; Corona, Giovanni; Colao, Annamaria; Pivonello, Rosario. - In: THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. - ISSN 0021-972X. - (2023). [10.1210/clinem/dgad042]
Fertility in Acromegaly: a single center experience on female patients during active disease and after disease remission
Pirchio, Rosa;Auriemma, Renata S;Verde, Nunzia;Garifalos, Francesco;Castoro, Michele;Conforti, Alessandro;Menafra, Davide;Pivonello, Claudia;de Angelis, Cristina;Alviggi, Carlo;Colao, Annamaria;Pivonello, Rosario
2023
Abstract
Context: Fertility represents a major concern in patients with acromegaly. Objective: Investigation of gonadal function and fertility rate in acromegalic women. Design: Retrospective study. Anthropometric, metabolic, hormonal parameters, and gynaecological ultrasound were evaluated at diagnosis and after disease control. Data about menstrual disturbances, pregnancy, and PCO-morphology (PCOM) were investigated at disease onset, diagnosis and after disease control. Setting: Referral center. Patients: 50 acromegalic women with disease onset within the reproductive age. Intervention: None. Main outcome measures: Prevalence of gonadal dysfunction and infertility. Results: At presumed disease onset, menstrual disturbances were reported in 32% of patients. Uterine leiomyoma, ovarian cysts and PCOM were diagnosed in 18%, 12% and 8%, respectively; 36.8% of patients were infertile. At diagnosis, menstrual disturbances were found in 58.1% (p = 0.02), being significantly more prevalent in patients with higher IGF-I quartiles (Q) (p = 0.03, Q1 vs Q4). Gynaecological ultrasound revealed uterine leiomyoma, ovarian cysts and PCOM in 39.1% (p = 0.04), 28.2% (p = 0.09), and 13% (p = 0.55), respectively. The infertility rate was 100% (p = 0.02). At disease control, menstrual disturbances (p = 0.05), particularly amenorrhea (p = 0.03), significantly persisted in patients with disease duration above than in those with disease duration below 5 years (median). Among patients with pregnancy desire, 73.3% conceived at least once, resulting infertility significantly decreased compared to diagnosis (26.7%, p = 0.01). At-term, pre-term deliveries and spontaneous abortions were recorded in 86.7%, 3.3% and 10%, respectively. No neonatal malformations and/or abnormalities were recorded. Conclusions: Gonadal dysfunction and infertility are common in acromegalic women within the reproductive age, being directly influenced by the disease status and/or duration.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
