Endocrine Abstracts

Introduction: Pituitary tumors leading to acromegaly are typically diagnosed as macroadenomas with the potential to infiltrate nearby tissues. If left untreated, acromegaly can result in systemic complications, such as hypertension, glucose intolerance, type 2 diabetes, and cardiovascular disease, leading to substantial comorbidities and a higher mortality rate.

Case report: We present a case of a 57-year-old patient who initially presented in 1993 with galactorrhea and hyperprolactinemia, treated with bromocriptine. Despite these symptoms, an MRI of the pituitary gland was not conducted. Over the years, the patient developed arterial hypertension and type 2 diabetes mellitus, along with a noticeable increase in shoe size, but did not seek medical help. The diagnosis of acromegaly was ultimately made in December 2020 during hospitalization for neurological symptoms (syncope). Brain MRI revealed an extensive pituitary macroadenoma measuring 50×37×40 mm with bilateral compression of the internal carotid arteries. Initial values of insulin-like growth factor 1 (IGF-1) were 95.9 nmol/l (reference interval 7.2-31.3), and growth hormone (GH) was insuppressible in an oral glucose tolerance test (OGTT). After two months, a partial transsphenoidal resection of the tumor was performed, with which neither clinical nor biochemical control of the disease was achieved. Following the multidisciplinary team’s decision, she received adjuvant Gamma-Knife radiotherapy for two months, and treatment with the octreotide was started. Since she was unresponsive to the first-generation somatostatin analog therapy pasireotide was introduced. After the administration of the second dose, symptomatic atrial fibrillation (AF) was recorded in the patient. Although AF is not described as a possible adverse event with pasireotide therapy considering the described prolongation of QT interval and possible worsening of arrhythmiay the therapy was discontinued. Given the circumstances, pegvisomant was considered as the next therapeutic option.

Conclusion: The challenge of achieving complete removal of the GH-producing pituitary macroadenoma during surgery increases the risk of a disease recurrence, and additional treatment methods, such as somatostatin analogs, dopamine agonists, and radiotherapy are often required. However, this population of patients is extremely vulnerable due to the development of complications such as various cardiac conditions and type 2 diabetes, making it difficult to choose the most appropriate pharmacotherapeutic option given their possible side effects and the potential for worsening comorbidities. Nevertheless, it is important to find the best therapeutic option for the patient to improve outcomes and prevent further progression of existing complications.