1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2024, Issue 1
  5. Article
Volume 2024, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: The somatostatin analog, pasireotide, is used for the treatment of acromegaly after the failure of surgery and/or first-line medical treatment.

Case Presentation: A 48-year-old male reported that during a workup for obesity in his home country, hyperprolactinemia was diagnosed and a 3.5 × 3.5 cm pituitary macroadenoma was identified on pituitary MRI. He received cabergoline for 6 months; then he was lost to follow-up. He presented at our Endocrine clinic 2 years later for treatment of obesity (BMI 49.5 kg/m2). Biochemical workup revealed that in addition to hyperprolactinemia (7,237 [normal: 85–323 mIU/L), he had acromegaly, evident by elevated insulin-like growth factor 1 (IGF-1) level (450 [normal: 88–210 µg/L]), and a positive growth hormone suppression test, secondary hypothyroidism, and secondary hypogonadism. Pituitary MRI showed that the adenoma encased parts of the left and right internal carotid arteries and encroached on the optic chiasm. Surgical excision was therefore not feasible. He was treated with cabergoline and later, long-acting release (LAR) octreotide. Prolactin levels were reduced with cabergoline, but IGF-1 levels did not respond to octreotide, and it was discontinued. The patient abandoned radiotherapy after two sessions. He was started on LAR pasireotide 40 mg every 4 weeks and continued on cabergoline 0.5 mg per week. His biochemical response was dramatic, with a near normalization of IGF-1 levels in 3 months. After 6 months from starting pasireotide, we increased cabergoline dose from 0.5 mg/week to 3 mg/week. Three months later, IGF-1 level was normalized. The patient developed type 2 diabetes as a side effect of pasireotide; however, this was well-controlled with medications.

Conclusions: The case suggests that pasireotide can provide marked biochemical improvement in acromegaly after the failure of both cabergoline monotherapy and cabergoline plus octreotide. This further confirms a potentially efficacious treatment regimen in treatment-resistant acromegaly with hyperprolactinemia.

© 2024 Baagar, Sadiq, Khan, Dabbous, Rohani, Licensee HBKU Press.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.17
2024-03-14
2024-04-29
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/1/qmj.2024.17.html?itemId=/content/journals/10.5339/qmj.2024.17&mimeType=html&fmt=ahah

References

  1. Biller BM, Colao A, Petersenn S, Bonert VS, Boscaro M. Prolactinomas, Cushing’s disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas. BMC Endocr Disord. 2010; 10:10. doi: 10.1186/1472-6823-10-10
     [Google Scholar]
  2. Gillam MP, Molitch ME, Lombardi G, Colao A. Advances in the treatment of prolactinomas. Endocr Rev. 2006; 27:(5):485−534. doi: 10.1210/er.2005-9998
     [Google Scholar]
  3. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:(2):273−88. doi: 10.1210/jc.2010-1692
     [Google Scholar]
  4. Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA. 2017; 317:(5):516−24. doi: 10.1001/jama.2016.19699
     [Google Scholar]
  5. Gomes-Porras M, Cárdenas-Salas J, Álvarez-Escolá C. Somatostatin analogs in clinical practice: a review. Int J Mol Sci. 2020; 21:(5):1682. doi: 10.3390/ijms21051682
     [Google Scholar]
  6. Valea A, Sandru F, Petca A, Dumitrascu MC, Carsote M, Petca RC, et al. Aggressive prolactinoma (Review). Exp Ther Med. 2022; 23:(1):74. doi: 10.3892/etm.2021.10997
     [Google Scholar]
  7. Lasolle H, Vasiljevic A, Borson-Chazot F, Raverot G. Pasireotide: a potential therapeutic alternative for resistant prolactinoma. Ann Endocrinol (Paris). 2019; 80:(2):84–8. doi: 10.1016/j.ando.2018.07.013
     [Google Scholar]
  8. Kopczak A, Renner U, Karl Stalla G. Advances in understanding pituitary tumors. F1000Prime Rep. 2014; 6:5. doi: 10.12703/P6-5
     [Google Scholar]
  9. Guo X, Zhang R, Zhang D, Wang Z, Gao L, Yao Y, et al. Hyperprolactinemia and hypopituitarism in acromegaly and effect of pituitary surgery: long-term follow-up on 529 patients. Front Endocrinol (Lausanne). 2021; 12:807054. doi: 10.3389/fendo.2021.807054
     [Google Scholar]
  10. Bonert VS, Melmed S. Acromegaly with moderate hyperprolactinemia caused by an intrasellar macroadenoma. Nat Clin Pract Endocrinol Metab. 2006; 2:(7):408-12; quiz following 412. doi: 10.1038/ncpendmet0222
     [Google Scholar]
  11. Oki Y. Medical management of functioning pituitary adenoma: an update. Neurol Med Chir (Tokyo). 2014; 54:(12):958–65. doi: 10.2176/nmc.ra.2014-0239
     [Google Scholar]
  12. Chiloiro S, Giampietro A, Bianchi A, Tartaglione T, Bima C, Vita MG, et al. Acromegaly can be cured by first-line pasireotide treatment? Endocrine. 2019; 64:(1):196–9. doi: 10.1007/s12020-019-01874-4
     [Google Scholar]
  13. Gadelha MR, Bronstein MD, Brue T, Coculescu M, Fleseriu M, Guitelman M, et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2014; 2:(11):875–84. doi: 10.1016/S2213-8587(14)70169-X
     [Google Scholar]
  14. Tahara S, Murakami M, Kaneko T, Shimatsu A. Efficacy and safety of long-acting pasireotide in Japanese patients with acromegaly or pituitary gigantism: results from a multicenter, open-label, randomized, phase 2 study. Endocr J. 2017; 64:(7):735–47. doi: 10.1507/endocrj.EJ16-0624
     [Google Scholar]
  15. Lasolle H, Ilie MD, Raverot G. Aggressive prolactinomas: how to manage? Pituitary. 2020; 23:(1):70–7. doi: 10.1007/s11102-019-01000-7
     [Google Scholar]
  16. Coopmans EC, van Meyel SWF, Pieterman KJ, van Ipenburg JA, Hofland LJ, Donga E, et al. Excellent response to pasireotide therapy in an aggressive and dopamine-resistant prolactinoma. Eur J Endocrinol. 2019; 181:(2):K21–7. doi: 10.1530/EJE-19-0279
     [Google Scholar]
  17. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14:(6):540–5. doi: 10.1093/sleep/14.6.540
     [Google Scholar]
  18. Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014; 99:(11):3933–51. doi: 10.1210/jc.2014-2700
     [Google Scholar]
  19. Giampietro A, Menotti S, Chiloiro S, Pontecorvi A, De Marinis L, Bianchi A, et al. De-escalation treatment with pasireotide for acromegaly: a long-term experience. Endocrine. 2023; 80:(3):505–10. doi: 10.1007/s12020-023-03325-7
     [Google Scholar]
  20. Colao A, Bronstein MD, Freda P, Gu F, Shen CC, Gadelha M, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab. 2014; 99:(3):791–9. doi: 10.1210/jc.2013-2480
     [Google Scholar]
  21. Gadelha MR, Wildemberg LE, Kasuki L. The future of somatostatin receptor ligands in acromegaly. J Clin Endocrinol Metab. 2022; 107:(2):297–308. doi: 10.1210/clinem/dgab726
     [Google Scholar]
  22. Gadelha MR, Gu F, Bronstein MD, Brue TC, Fleseriu M, Shimon I, et al. Risk factors and management of pasireotide-associated hyperglycemia in acromegaly. Endocr Connect. 2020; 9:(12):1178–90. doi: 10.1530/EC-20-0361
     [Google Scholar]
  23. Colao A, Bronstein MD, Brue T, De Marinis L, Fleseriu M, Guitelman M, et al. Pasireotide for acromegaly: long-term outcomes from an extension to the Phase III PAOLA study. Eur J Endocrinol. 2020; 182:(6):583–94. doi: 10.1530/EJE-19-0762
     [Google Scholar]
  24. Gadelha M, Bex M, Colao A, Pedroza García EM, Poiana C,Jimenez-Sanchez M, et al. Evaluation of the efficacy and safety of switching to pasireotide in patients with acromegaly inadequately controlled with first-generation somatostatin analogs. Front Endocrinol (Lausanne). 2019; 10:931. doi: 10.3389/fendo.2019.00931
     [Google Scholar]
  25. Gadelha M, Marques NV, Fialho C, Scaf C, Lamback E, Antunes X, et al. Long-term efficacy and safety of pasireotide in patients with acromegaly: 14 years’ single-center real-world experience. J Clin Endocrinol Metab. 2023 Nov 17; 108:(12):e1571–9. doi: 10.1210/clinem/dgad378
     [Google Scholar]
  26. Witek P, Bolanowski M, Szamotulska K, Wojciechowska-Luiniak A, Jawiarczyk-Przyby?owska A, Ka?u?ny M, et al. The effect of 6 months’ treatment with pasireotide LAR on glucose metabolism in patients with resistant acromegaly in real-world clinical settings. Front Endocrinol (Lausanne). 2021; 12:633944. doi: 10.3389/fendo.2021.633944
     [Google Scholar]
  27. Stelmachowska-Bana? M, Czajka-Oraniec I, Tomasik A, Zgliczy?ski W. Real-world experience with pasireotide-LAR in resistant acromegaly: a single center 1-year observation. Pituitary. 2022; 25:(1):180–90. doi: 10.1007/s11102-021-01185-w
     [Google Scholar]
  28. Wolf P, Dormoy A, Maione L, Salenave S, Young J, Kamenický P, et al. Impairment in insulin secretion without changes in insulin resistance explains hyperglycemia in patients with acromegaly treated with pasireotide LAR. Endocr Connect. 2022; 11:(12) :e220296. doi: 10.1530/EC-22-0296
     [Google Scholar]
  29. Ruiz S, Gil J, Biagetti B, Venegas E, Cámara R, Garcia-Centeno R, et al. Magnetic resonance imaging as a predictor of therapeutic response to pasireotide in acromegaly. Clin Endocrinol (Oxf). 2023 Oct; 99:(4):378–85. doi: 10.1111/cen.14946
     [Google Scholar]
  30. Puig-Domingo M, Bernabéu I, Picó A, Biagetti B, Gil J, Alvarez-Escolá C, et al. Pasireotide in the personalized treatment of acromegaly. Front Endocrinol (Lausanne). 2021; 12:648411. doi: 10.3389/fendo.2021.648411
     [Google Scholar]
  31. Lim DST, Fleseriu M. Personalized medical treatment of patients with acromegaly: a review. Endocr Pract. 2022; 28:(3):321-32. doi: 10.1016/j.eprac.2021.12.017
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2024.17
Loading
Successful medical management of a pituitary macroadenoma with features of resistant acromegaly and hyperprolactinemia using pasireotide
Qatar Medical Journal 2024, 17 (2024); https://doi.org/10.5339/qmj.2024.17
/content/journals/10.5339/qmj.2024.17
/content/journals/10.5339/qmj.2024.17
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): acromegaly, case report, hyperprolactinemia, pasireotide and pituitary macroadenoma

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error