Endocrine Abstracts

Introduction: The concept of life-long medical therapy for acromegaly has recently been challenged. Hormonal remission for up to 48 months after stopping somatostatin analogues in acromegalic patients has recently been reported. Herein, we present a further case showing the longest remission yet in growth hormone levels after somatostatin analogue treatment.

Case: In 1987, a 43 year old man was diagnosed with acromegaly [nadir GH on oral glucose tolerance test (OGTT) 33.1 mU/l] attributed to a somatotroph macroadenoma (MRI: L-sided 11 mm intrasellar adenoma). Immediately, he proceeded to TSA; post-operative OGTT showed nadir GH at 4.8 mU/l. At that time, the patient had no further treatment, as he was clinically well. In the following years, radiotherapy was discussed, but the patient declined. In 1995, his nadir GH on the OGTT was 2.7 mU/l. In July 1998, he finally agreed on medical treatment with octreotide LAR (20 mg/4 weeks); before this, his mean GH on the GH day curve was 5.4 mU/l and his IGF-I was 26.6 nmol/l (7.5–30). He achieved ‘safe’ mean GH levels 1.1 mU/l and his IGF-I remained normal 18 (7.5–30). During the next 3 years, the dose interval was extended successfully up to 12 weeks. In October 2001, he had his last octreotide injection and his mean GH was 1.3 mU/l with IGF-I at 16.7 nmol/l (7.5–30). He had his mean GH assessed regularly until 2003, which remained at ‘safe’ levels. Annual evaluations demonstrated normal IGF-I 9.7 nmol/l (7–28) and his OGTT in 2005 and 2008 showed nadir GH at 0.35 mU/l and 0.45 mU/l, respectively.

Conclusions: This is the first reported case of a patient with active acromegaly remaining cured for 8 years following withdrawal of long-acting somatostatin analogue therapy demonstrating that life-long requirement of somatostatin analogues needs further evaluation.