Endocrine Abstracts

Background: The post-treatment follow-up of acromegaly involves assessing treatment efficacy through biochemical evaluation, imaging studies for residual/recurrent disease, and monitoring clinical signs. IGF-1 normalization, typically achieved 12 weeks post-surgery, is considered a success; however, delayed normalization has been observed. Discordant GH/IGF-I results may indicate persistent somatotroph GH secretion and tissue responsiveness. We present a case where maximal medical treatment and two surgeries failed to normalize IGF-1 levels, leading to the utilization of Pasireotide.

Case: A 59-year-old lady attended follow up endocrine clinic in Oct 2023 with elevated IGF-1 levels (>1.3 × ULN (Upper Limit of Normal). She was first diagnosed with acromegaly in 2002. Despite surgical debulking and ongoing medical treatments (Lanreotide and Cabergoline), her IGF-1 remain persistently elevated. A repeat surgical debulking in 2012 achieved partial success, leaving a small residual disease. The patient declined radiotherapy due to concerns about side effects. At that point, Pegvisomant was considered as an option, however, funding was not available for the patient. Given the absence of symptoms, slightly elevated IGF-1 levels (1.2 × ULN) were deemed acceptable, and medical treatment continued. In 2017, Cabergoline was discontinued due to intolerance, and Quinagolide was added to manage persistently elevated IGF-1. Repeat MRI in 2022 showed a reduction in residual disease size. Despite tolerating Quinagolide well, IGF-1 levels rose again in 2023, leading to the initiation of Pasireotide after multidisciplinary team discussion.

Discussion Points: 1. Discordant IGF-1 levels post-acromegaly treatment and its impact on long-term management.2. Challenges and considerations in managing residual acromegaly post-surgery, particularly when surgical and medical interventions show limited success.3. Effectiveness and considerations for using Pasireotide in cases of persistent acromegaly with elevated IGF-1 levels despite conventional treatments.4. Discuss the potential benefits and side effects associated with Pasireotide in this context