Endocrine Abstracts

Introduction: Surgery is the primary therapy in most acromelagic patients. When persistent disease is observed, adjuvant medical therapy is used. Pasireotide is a somatostatin analogue (SSA) not approved for acromegaly therapy yet, but with a potentially better response, given that it binds to four out of five somatostatin receptors.

Materials and methods: We present the case of an acromegalic patient with resistance to many therapies and response to treatment with pasireotide.

Clinical case: A woman diagnosed in 1993, at the age of 24 years, of GH-producing pituitary macroadenoma (3×2×2.5 cm). She underwent surgery twice, with only partial resection, followed by radiotherapy and medical treatment. She was on s.c. octreotide, with partial response. Later on, bromocriptine was added with no improvement in GH/IGF1 levels. MRI showed empty sella at 1996. In 2001 medical therapy was switched to a dose of 30 mg of octreotide LAR/4 weeks plus a maximum tolerated dose of cabergoline (2 mg/week), without normalisation of IGF1 levels. In 2008 pegvisomant (15 mg s.c. daily) was used, achieving normal levels of IGF1, but causing headache and lipohypertrophy. On 3 days/week administration (120 mg/week), elevation in IGF1 level and persisting lipohypertrophy were observed. We requested compassionate-use treatment with pasireotide 40 mg/4 weeks. First dose on June 6th 2012 and increased to 60 on 2013.

In November 2013 a basal glucose value of 145 mg/dl and HbA1c 6.7% were observed. Metformin and later on vildagliptin were indicated and glucose control was achieved.

Conclusion: Pasireotide has got a clinical improvement and IGF1 control in this patient. Diabetes is under control on dual therapy.