Clinical Case 1

Acromegaly features develop insidiously over decades, often resulting in a delay of 7-10 years or more in diagnosis after the estimated onset of symptoms. Among clinical features, female reproductive disorders, including menstrual abnormalities, galactorrhea, and decreased libido, are commonly complained in acromegaly patients. We report the management of 34-year-old woman with a history of oligo-amenorrhea, acne, and hirsutism by age 28, infertility, and gradually worsening headache. At clinical evaluation, the patient presented with mild clinical features of acromegaly and PCOS-like phenotype. Acromegaly due to a GH-secreting pituitary macroadenoma was diagnosed, and the patient underwent first-line transsphenoidal surgery. At 3 months postsurgery evaluation, the patient started first-generation somatostatin analogs (SSA), due to persistent acromegaly. Despite high dose of SSA, the patient remained biochemically uncontrolled and pegvisomant (PEG) monotherapy was started. At age 38, the patient spontaneously conceived. PEG therapy was discontinued after pregnancy confirmation, and the patient was regularly followed during pregnancy. She safely delivered a healthy baby; no complications were reported during pregnancy and delivery. The present clinical case underscores how an earlier diagnosis is crucial for the management of acromegaly, and how the availability of multiple effective treatments for acromegaly could positively impact on clinical manifestations and the female fertility outcome in acromegaly.