Pregnancy in Women Previously Treated for an Adrenocortical Carcinoma

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Abstract

Context:

Adrenocortical carcinomas (ACCs) are rare, aggressive tumors, of which some express receptors for estradiol, progesterone, and/or human chorionic gonadotoropin. Because this disease is encountered frequently in young women, pregnancy is a relevant issue.

Objective:

to evaluate the impact of pregnancy on outcome of patients previously treated for ACC.

Design/Setting:

retrospective observational multicenter study of the European Network for the Study of Adrenal Tumors.

Patients:

Seventeen ACC patients (21 pregnancies), becoming pregnant at least 3 months after the initial treatment, were compared with 247 nonpregnant ACC patients less than 47 years old. A control group of 34 patients matched for age, sex, and tumor stage was used for survival analysis.

Main Outcome Measure(s):

Overall survival, tumors characteristics at diagnosis, pregnancy outcome.

Results:

All 17 patients with pregnancies had localized ACC. The median time between surgery and conception was 4 years (0.3–12 y). Two pregnancies were terminated at 8 weeks. Sixteen women gave birth to 19 live infants. With exception of 1 (presumably unrelated) cardiac malformation, no severe fetal or maternal complication was observed. After a median follow-up time of 8.36 years and 5.26 years after the first conception, 1 of the 17 patients had died and 5 had experienced a recurrence, among whom 3 occurred before conception. Overall survival was not significantly different between the “pregnancy group” and the matched controls.

Conclusion:

Pregnancy in patients previously treated for ACC seems to not be associated with worse clinical outcome, although a “healthy mother effect” cannot be excluded.

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