Pregnancy in women previously treated for an adrenocortical Carcinoma

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 forACCseems to notbeassociated with worse clinical outcome, although a "healthy mother effect" cannot be excluded.