Endocrine Abstracts

Somatostatin analogues (SSA) are first/second line treatment in the management of acromegaly and Cushing disease (CD), however, recent data suggest that they can be effective in the management of non-functioning pituitary neuroendocrine tumour (PitNET). We present one clinically silent gonadotroph PitNET treated with octreotide and two silent corticotroph PitNETs treated with pasireotide.

Case 1: A 50-year-old female presented with frontal headache and visual field deficits. In magnetic resonance imaging (MRI) a pituitary mass 30×34×34 mm with suprasellar expansion, compressing third ventricle and optic chiasm, invading sphenoid and cavernous sinus was described. She underwent transsphenoidal surgery (TSS), however, due to residual mass 34×28×37 mm a second TSS was performed. In histopathology gonadotroph PitNET; LH-, FSH +, SF1++, Ki-67<1%, SSTR2A++ was described. In control MRI 32×32×22 mm mass was visualised, patient has been continuously suffering from severe headaches. After multidisciplinary tumour board Octreotide LAR 20 mg/monthly was introduced. After 6 months of treatment, milder headaches and stable pituitary mass were noted.

Case 2: A 33-year-old male was admitted to Emergency Department due to severe headaches (8–9/10 using numbering rating score (NRS)) and vomiting. Sellar tumour (39×33×55 mm) and cerebral edema were found. External ventricular drainage and TSS were performed. Histopathology results showed silent adenoma subtype 1 (densely granulated), Ki67<1%. Three months later, MRI showed progression of PitNET (40×39×30 mm). Subsequently, patient underwent two emergency TSS and stereotactic fractionated radiotherapy. Treatment with temozolomide, pasireotide, cabergoline, radiotherapy was introduced. After 18 months of combined therapy stable disease was observed. Implementation of pasireotide resulted in spectacular decrease of headaches (initially 9–10 to none /10 using NRS).

Case 3: A 31-year-old male presented in our clinic due to headaches and bitemporal hemianopsia. In MRI PitNET was found (22×19×23 mm) and active CD was diagnosed. TSS was performed in 2013. Histopathology results showed corticotroph PitNET with Crook cells. Postoperatively, PitNET progression (17×26×13 mm) was observed with no overt CD. In 2022, due to worsening of headaches and vision loss, second TSS was performed. Histopathologists described corticotroph tumor with Crook cells with ATRX mutation of uncertain significance. Pasireotide implementation is planned. Pharmacotherapy with SSA in the cases of non-functioning PitNETs allows the stabilisation of the disease, decrease the headaches and can be considered as an alternative for the next neurosurgeries, however, further multicentre studies should be carried out.