Management and safety of somatostatin receptor ligands and pegvisomant in pregnant women with acromegaly: a narrative review of the literature.

PURPOSE: Pregnancy in acromegaly is a rare event. Its management is still a challenge given the lack of data, the risk of tumor progression and maternal-fetal complications. This study aims to evaluate the impact of different treatment strategies, particularly somatostatin receptor ligands (SRL) and pegvisomant (PEG), on maternal and neonatal outcomes through a comprehensive review of the literature.

METHODS

We performed a narrative review of the literature. A PubMed search was performed using the keywords "acromegaly AND pregnancy", combined with treatment-related terms, covering publications from January 1, 1988, to January 21, 2026. No publication type restrictions were applied. Additional articles were identified through manual reference screening. Articles published in English and Italian were included.

RESULTS

A total of 44 articles were identified, comprising 120 patients and 134 pregnancies; we further contribute an additional case of pregnancy with pasireotide exposure, representing the third reported case of pasireotide exposure during pregnancy. Medical management was categorized as follows: treatment withdrawal before conception (n = 40), discontinuation upon pregnancy confirmation (n = 47), and continuation or modification throughout gestation (n = 30). Symptom worsening occurred in 16.7-40%. Maternal complications included gestational diabetes (5.6-18.8%) and pre-eclampsia (2.8-10.3%). Overall, fetal outcomes were favorable, with only one congenital malformation. Breastfeeding was successfully achieved in most cases.

CONCLUSION

Pregnancy in acromegaly is generally characterized by clinical stability, supporting the safety of treatment withdrawal upon conception in most patients. While early therapy discontinuation is standard, SRL and/or PEG treatment is a viable option for patients requiring tumor and biochemical control. Individualized multidisciplinary management is essential.