Endocrine Abstracts

Background: Although the excision of ACTH-producing tumors is the principal treatment for Cushing’s disease (CD), pharmacologic treatment has a well-established role. As corticotroph adenomas express somatostatin (SST) receptors (SSTRs), pasireotide – a pluripotent somatostatin analogue, acting on four of five SSTRs has a potential role in treatment of CD among various medical agents.

Case report: We report a 39-year-old female with recurrence of Cushing’s disease (CD) 9 years after the initial successful pituitary surgery. Medical treatment with ketoconazole has to be stopped due to headache and myalgia, therefore pasireotide at dose 0.6 mg s.c. twice daily was started. Increased serum cortisol (FP) levels with loss of circadian rhythm (779–398–435–627–607 nmol/l at 0800–1600–2000–2400–0800 h respectively), with increased basal urinary free cortisol (UFC) (1767–1848 nmol/day), non-suppressible in 2 mg (FP 231 nmol/l, UFC 358 nmol/day) and non-supressed ACTH levels (45.0 pg/ml) decreased even 4 days after starting the treatment – FP levels 281–156–206–140–300 nmol/l (taken at same times), ACTH 32.7 pg/ml. After 2 months, FP were 517–357–181–360–339 nmol/l, UFC 987.798 nmol/day, ACTH (39.7 pg/ml) was not changed. Parameters of glucose metabolism were changed non-significantly – HbA1c (IFCC) 3.91–4.48% (normal value 2.0–4.2%), mean daily glucose levels 6.47–7.27 mmol/l (normal values 3.50–5.90 mmol/l).

Discussion:: After 2 months of the treatment, we stated good efect of treatment, with decrease of ACTH (12%), FP (basal 34%, midnight 43%, average 36%), and UFC levels (49%). Patient tolerated treatment with pasireotide well, but suffered from mild persistent diarrhea as an adverse effect of the treatment. Diarrhea is potential rare side effect of SST-analogs and was also recorded as the most frequent side effect of pasireotide in pilot study by Colao et al. (NEJM 2012).