Endocrine Abstracts

Transsphenoidal surgery still appears to be the best option for most of the patients with GH secreting adenomas. In many cases the biochemical cure targets are not reached and the patient needs adjuvant therapy. Alternatives include medical therapy with somatostatin analogues, GH-receptor antagonists and dopamine agonists. These drugs can be used alone or in combination. Radiation therapy with conventional fractionated photons or radiosurgery with proton beam could also be effective in some cases. We present the clinical case of a 32 year old man, who first came to us in October 2008 due to acral enlargement of hands and feet, prognatism and fatigue. He had a GH level of 52 μg/l and an IGF1 level of 839 ng/ml at the time of diagnosis. After 6 months of therapy with Octreotide (Sandostatin LAR) 20 mg/28 days both of them decreased (IGF1 by 70% and GH by 80%).This treatment was maintained for 2 years, with the persistence of high levels of IGF1 (X 2009- 677 ng/ml, VIII- 767 ng/ml), but with the decrease of the tumour and the levels of GH. In august 2011 the patient underwent transsphenoidal surgery (difficult to perform due to severe bleeding and anatomical abnormalities), followed one month later by Gamma Knife. At that point he developed partial pituitary insufficiency (thyreotrop and gonadotrop), hypertension and impaired fasting glucose, for which he started medical treatment. From january 2012 he received again somatostatin analogues (the starting dose was octreotide 20 mg every 28 days for 6 months, followed by 30 mg/28 days) without the normalisation of IGF1 (X 2012-631 ng/ml, VI 2013-403 ng/ml). Because the IGF1 levels were still elevated the dose of octreotide was increased at 40 mg/28 days and GH receptor antagonists (Pegvisomant) was associated (III 2014 10 mg/day s.c.). The following IGF1 levels are still high (V 2014-493 ng/ml, VII 2014 -587 ng/ml, XII 2014-541 ng/ml). The particularity of the case is represented by the age of the patient and by the fact that throughout a relative short period of time he received the latest available therapy in acromegaly.