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Endocrine Abstracts (2021) 73 AEP533 | DOI: 10.1530/endoabs.73.AEP533

ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)

Improved response to somatostatin analogue (SSA) therapy in acromegaly following treatment pause

Roby Rajan 1 , D Bhatt 1 , S Philip 1 , AJ Graveling 1 , W Bashari 2 , M Gurnell 2 & P Abraham 1


1Aberdeen Royal Infirmary, Department of Endocrinology, Aberdeen, United Kingdom; 2Welcome–MRC Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge Endocrine Molecular Imaging Group, Cambridge, United Kingdom


Background/methods

Patients with uncontrolled acromegaly or receiving high cost medical therapy despite initial treatment, usually transsphenoidal surgery (TSS), were considered for a ¹¹C-methionine PET-CT scan (11C-Met PET-CT). This imaging technique may identify a target for TSS or radiotherapy when MRI appearances are inconclusive1. In preparation, four patients on long-term SSA were taken off treatment 3 months prior to the scan. Due to issues with the cyclotron, 2 scans had to be deferred (increasing the duration of the treatment pause). We reintroduced SSA therapy in all 4 patients and noticed an improvement in biochemical response.

Results

Patient 1 2 3 4
Primary therapy Medical TSS TSS TSS
Treatment prior to 11C-Met PET-CT Octreotide LAR
20 mg
6-weekly
Octreotide LAR 10mg
4-weekly
Lanreotide ATG
120 mg
4-weekly
Lanreotide ATG
120 mg
4-weekly
IGF1ΧULN¥ at diagnosis (year) 1.8 (1999) 6.1 (2011) 4.6 (2012) 2.1 (1994)
Duration of SSA treatment (years) 18 1 4 23
IGF1ΧULN¥ at treatment pause 1.07 1.14 0.78 1.41
Duration of
treatment pause
(months)
8 6 4 8
IGF1ΧULN¥ prior to treatment restart 1.5 1.13 1.0 1.33
Duration of treatment post SSA restart (years) 3 2 3 3
Latest IGF1ΧULN¥ 0.87 0.98 1.06* 0.8
11C-Met PET-CT outcome Awaiting Surgery Deferred No surgical target Deferred
Current treatment Octreotide LAR
20 mg
6-weekly
Octreotide LAR
10 mg
6-weekly
Lanreotide ATG 120 mg 12 weekly* Lanreotide ATG
120 mg
4-weekly

¥ Upper limit of normal; * Dose frequency increased from 12 weekly to 10 weekly (patient living abroad and had requested reduced dosing frequency)

Discussion

Tachyphylaxis is defined as a diminishing response to successive doses of a medication, rendering it less effective. SSA therapy is not anticipated to demonstrate tachyphylaxis in acromegaly2, although there has been one report of partial tachyphylaxis3. Our four patients appear to have experienced a resensitisation to SSA therapy following a short treatment pause as evidenced by improved biochemical control; despite two of them having a reduced dosing frequency. The possibility of a treatment pause improving the sensitivity and biochemical control following reintroduction of SSA therapy has been reported in polycystic liver disease4.

References

1. Koulouri O et al. European Journal of Endocrinology (2016).

2. Lamberts SWJ et al. European Journal of Endocrinology (2019).

3. Wahid ST et al, European Journal of Endocrinology (2002).

4. René M et al, Therapeutic Advances in Gastroenterology (2018).

Volume 73

European Congress of Endocrinology 2021

Online
22 May 2021 - 26 May 2021

European Society of Endocrinology 

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