Silent Somatotropic Adenoma and
Pregnancy: About A Case
Sara askaoui1*, Guizlane el mghari1, Maria Dref2, Sana Rafi1, Hanane Raiss2 and Nawal el ansari1
1 Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of marrakech, Morocco
2 Department of Pathology, University Hospital of marrakech, Morocco
Submission: August 25, 2018;Published: December 06, 2018
*Corresponding author: Sara askaoui, Department of Endocrinology, Diabetology and Metabolic Diseases, University Hospital of marrakech, Imm Dalia 2 c, N°18, Albadii, amerchich, Marrakech, Maroc Morocco
How to cite this article: Sara a, Guizlane el m, Maria D, Sana R, Hanane R,et al. Silent Somatotropic Adenoma and Pregnancy: About A Case. Glob J
Reprod Med. 2018; 6(3): 555687. DOI:10.19080/GJORM.2018.06.555687.
Somatotropic adenomas are classically a source of hypersecretion of growth hormone (GH) and consequently of insulin growth factor 1 (IGF1) and responsible of the clinical signs of acromegaly. Rarely, these adenomas remain “silent”, without any obvious clinical manifestation. They can then be screened on the basis of a systematic assay of growth hormone under oral glucose tolerance test (GH/ OGTT) and IGF1 or can be diagnosed only in the immunohistochemical study as in the case of a patient we report and the evolution of her disease during pregnancy.
Silent somatotropic adenomas correspond to a rare entity. Their diagnosis is based on screening by the systematic determination of GH under oral glucose tolerance test (OGTT) and insulin growth factor 1 or the immunohistochemical study, in the absence of clinical signs of acromegaly [1,2]. Pregnancy in acromegalic women is an exception. Data from the literature report the absence of fetal malformation, an increase in adenomatous volume that is rarely symptomatic, a possible risk of gestational diabetes and gestational hypertension in women not controlled by pre-pregnancy drug therapy [3,4]. Variations in somatotropic function have rarely been studied. The aim of this work is to report the case of pregnancy in a patient followed for a silent somatotropic adenoma.
A 33-year-old patient who was seen for secondary amenorrhea with anamnesis: asthenia, frontal headache, and galactorrhea. The clinical examination did not indicate a dysmorphic syndrome, noted the presence of multipored galactorrhea caused. The results of the hypophysiogram were as follows:
• Prolactin: 153 ng / ml,
• TSHus: 1.2 mUI/l, T4L: 9pmol/l (12-22),
• FSH: 1.3 UI/L, LH: 0,9 UI/L and
• Oestradiol: 9pmol/l.
The somatotropic axis has not been explored.
Pituitary magnetic resonance imagery (MRI) revealed a pituitary macro-adenoma of 18 *13*16 mm, repressing the optic chiasm and cavernous sinuses (Figure 1), with the visual field: an enlargement of the blind spot with an amputation of the infero-nasal area of the left eye. The adenoma was treated by cabergoline 10mg per week for one year with substitution of thyrotropic deficiency. The evolution at one year was marked by the persistence of the latter, with a control prolactinemia at 0,22 ng / ml. The controlled pituitary MRI noted an increase (by 17%) of the tumor volume: 21 * 19 * 15.3mm, with a visual field always altered.
An echo-heart was requested as part of the follow-up,
further, to increase the dose of cabergoline which revealed the
presence of an average tricuspid insufficiency. The latter was
declared at the pharmacovigilance center, then, the indication for
transphenoidal surgery was raised. The consistency of the tumor
was fibrous and haemorrhagic making it impossible to extract.
Immunohistochemical analysis returned to a typical somatotropic
adenoma (Ki 67 <3%, P53 not done) (Figure 2).
Pituitary MRI for control at 3 months post-operative showed
constant tumor volume with some necrosis areas with IGF1 at
131ug/l (112-300). The patient was seen after being pregnant at
19 weeks; whose follow-up did not indicate gestational diabetes,
nor gravid arterial hypertension, nor signs of intracranial
hypertension, nor fetal malformation. Radiological control at 3
months of the postpartum, showed the stability of the tumoral
volume with a level of IGF1 always normal. Surgical revision
was indicated with supplemental treatment with somatostatin
The somatotropic adenomas are often identified because of
the clinical consequences they cause (dysmorphism). Occasional
cases of subclinical adenomas have been described in the
literature, where only pathological examination reveals a positive
immuno-labeling for GH (somatotropic, cortico-somatotropic and
Their frequency is poorly studied , because in the absence
of immune-histochemical study, a nonfunctional adenoma is
concluded and IGF1 is not carried out as part of the follow-up;
all this leads to a delay in diagnosis, which later gives rise to
dysmorphism with the various complications of hypersecretion of
GH . For this, a preoperative evaluation of the concentrations
of GH / OGTT and IGF-1 is of interest, in addition to the complete histopathological analysis: immunohistochemistry of GH,
prolactine, expression of somatostatin receptors and evaluation of
proliferation (number of mitoses, Ki-67 index and p53 expression).
The treatment of this type of adenoma is initially based on surgery,
then somatostatin analogues and lastly on temozolamide and
radiotherapy in case of signs of aggression [8,9].
Pregnancies in these patients treated for acromegaly are often
not accompanied by obstetric or fetal complications, but a maternal
follow-up is necessary in order to diagnose gravid hypertension
and gestational diabetes. On the other hand, a clinical monitoring
of pituitary tumor syndrome is necessary in women with nonoperated
GH macroadenoma before pregnancy .
Silent somatotropic adenoma is a distinct entity from the
usual cases of acromegaly, as it may be a beginning of the disease,
or a benign aspect of the disease. The systematic implementation
of the GH / OGTT and IGF1 preoperatively associated with the
immunohistochemical study is of great interest, allowing the
screening of this entity and ensuring appropriate monitoring.
Clinical monitoring of pituitary tumor syndrome is necessary in
pregnant women with non-operated GH macroadenoma.