ECE2021 Audio Eposter Presentations Late Breaking (114 abstracts)
The first comprehensive study of the clinical response of a cohort of acromegalic patients with somatostatin responsive headache
Sonia Kaniuka-Jakubowska 1 , 2 , Miles J Levy 3 , Aparna Pal 2 , Dayakshi Abeyaratne 2 , 4 , William Drake 5 , Nikolaos Kyriakakis 6 , Robert D Murray 6 , Steve M Orme 6 , Shailesh Gohil 3 , Antonia Brook 7 , Graham Leese 8 , Márta Korbonits 9 & John Wass 2
1Medical University of Gdansk, Department of Endocrinology and Internal Medicine, Gdask, Poland; 2Oxford University Hospitals NHS Foundation Trust, Department of Endocrinology at the Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, United Kingdom; 3Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Department of Endocrinology, Leicester, United Kingdom; 4National Hospital of Sri Lanka, Diabetes and Endocrinology Unit, Colombo, Sri Lanka; 5St Bartholomew’s Hospital, Barts Health NHS Trust, Department of Endocrinology, London, United Kingdom; 6Leeds Centre for Diabetes & Endocrinology, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Department of Endocrinology, Leeds, United Kingdom; 7Royal Devon and Exeter Hospital, MacLeod Diabetes and Endocrinology Centre, Exeter, United Kingdom; 8NHS Tayside, Department of Endocrinology, Dundee, United Kingdom; 9Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, Centre for Endocrinology, William Harvey Research Institute, London, United Kingdom
It is known that acromegaly may be associated with headache as a significant co-morbidity. Amongst all acromegaly headache patients, there is a unique group with specific types of severe headache that fail to improve despite acromegaly therapy and are resistant to conventional analgesics, however, immediately respond to subcutaneous short-acting (SA) somatostatin analogue (SSA) treatment. We have surveyed 8 tertiary specialist UK centres and identified 18 patients (6 females) on the basis of their presentation with SSA-responsive acromegaly associated headache. The phenotype was mostly chronic migraine (78%) and International Headache Society pituitary-tumour associated headache (22%). All patients reported a daily, persistent headache (apart from those on long-acting (LA) SSA) with intense severity (mean 9 on 0–10 pain scale). No headache cessation after surgery was observed (although in 27.8% improvement was reported). All patients presented with macroadenoma, mostly after incomplete resection (94.1%) and headache ipsilateral to remnant tissue (93.8%). All patients failed to respond to conventional analgesic treatment. However, they all observed headache relief after SA-SSA injection within minutes, lasting up to 6 hours. The frequency of SA-SSA injections was higher when taking SA-SSA alone (n = 8), than in combination treatment with SA- and LA-SSA (n = 10) for disease control (mean 10.4 [range 3–6] SA-SSA alone; vs mean 3.7 [range 0–7] SA with LA-SSA). Headache was long-lasting, persisted up to 33 years after diagnosis (mean 18 [range 6–33]), and only 4 patients were in headache remission. 77.8% of patients achieved biochemical control, although 71.4% of this group still had headache despite normal IGF-1. Elapsed time after radiotherapy in patients with headache remission was higher than in patients still struggling with headache (median 21 vs 10 years). Headache, as a significant co-morbidity in a specific group of patients with acromegaly can be persistent, severe, unrelieved after surgery, and not correlated with biochemical control, while reacting to SA-SSA, which appears to have a modulatory role with its still unknown mechanism.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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