Endocrine Abstracts

A 56 year old female who attends the general endocrine outpatient appointments for acromegaly secondary to pituitary macroadenoma diagnosed in March 2022. She has a history of breast cancer (HER2+), papillary thyroid cancer and is under active treatment for metastatic non-small cell lung cancer (adenocarcinoma) diagnosed in 2019. Her initial MRI pituitary was performed in March 2022 after an interval scan from oncology to assess disease response to treatment identified a pituitary fullness. Her MRI demonstrated a 1.3 × 1.6 × 1.5 cm solid sella mass consistent with a pituitary macroadenoma. Her initial pituitary panel was performed after the MRI, which demonstrated normal thyroid function, gonadotropins consistent with menopause, normal ACTH, prolactin slightly elevated at 1103 mU/l and IGF-1 120 nmol/l with growth hormone 14.30 mg/l (see table 1). She underwent two synacthen tests, which were both normal. In order to complete the work-up, she also had an HbA1 c performed which was 44. Given her complicated history of concurrent metastatic disease, she was deemed not suitable for pituitary resection. She was commenced on Lanreotide to treat her acromegaly. On subsequent visits, her main complaints were hair loss since commencing treatment for acromegaly and she found that more distressing than any other symptoms caused by her comorbidities. The decision was made to switch her from Lanreotide to Pegvisomant given the distress caused by the alopecia, which resulted in marked improvement.This case highlights alopecia, a documented side effect of lanreotide treatment, which has been reported as a common side effect (>/=1/100 to <1/10) as described in the summary of product characteristics. Although this patient was on concurrent treatment with osimertinib (tyrosine-kinase inhibitor) for her metastatic lung disease, the side effect of alopecia was accounted for by the lanreotide given the temporal relationship of the timing of hair loss and subsequent improvement with pegvisomant. Furthermore, routine screening for known side effects of treatment should always be undertaken on routine endocrine clinic visits for patient wellbeing.