Endocrine Abstracts

The issue of treatment-resistant pituitary tumour growth remains relatively under-explored. We describe the case of a gentleman whose diagnosis and management involved several medical disciplines and his management proved challenging over the long term.

A 47-year-old gentleman who was seen by a variety of specialists before and after diagnosis for the complications of his aggressive acromegaly.

Initially seen in 1997 by an Occupational Health Physician as he complained of enlargement of both hands making his work difficult. He was subsequently referred on to a Urologist because of erectile dysfunction. The urologist queried the diagnosis of diabetes and arranged for him to have an OGTT and see a Diabetic nurse specialist. The DSN found that he had impaired glucose tolerance and gave diet and lifestyle advice.

He was subsequently reviewed by his General Practitioner who thought that he may have an underlying endocrinopathy and referred him on to see a Cardiologist for features of heart failure, and…

An endocrinologist who diagnosed him with Acromegaly. He was found to have a large pituitary macro-adenoma which had eroded the pituitary fossa and cavernous sinus.

He was seen by a Neurosurgeon who performed two trans-sphenoidal debulking operations with mixed results. He went on to have Radiotherapy administered by Nuclear Medicine.

Following these treatments he was still found to have active disease with elevated IGF-1, despite medical management with Octreotide. The patient subsequently declined further radiotherapy due to concerns about cognitive decline and his tumour was not felt to be amenable to further neurosurgery. He is due to be considered for treatment with Pegvisomant (a growth hormone receptor antagonist).

There exists a clear need to study the causes and management of treatment-resistant Acromegaly, particularly in terms of tumour progression. Well-designed MRI studies in patients potentially at risk from an aggressive tumour would be very useful to verify the true rates of therapeutic failure across all treatment modalities.