Filiz EKŞİ HAYDARDEDEOĞLU, Okan BAKINER

Pasireotide: A new option for treatment of acromegaly

Acromegaly is characterized by excess production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Although surgery is the first treatment option, somatostatin receptor analogs (SSRAs) can be used in selected cases which surgery is contraindicated. A patient who has been diagnosed as acromegaly was admitted to our hospital. Hypophyseal adenomectomy had been performed one year ago. The patient was taking lanreotide for 6 months and disease was not under control. She had loss of vision. Although she had a residual tumor, second surgery couldn’t be performed due to the location of tumor. The patient was followed for 6 years. Radiotherapy and other medical treatment options were tried but none of them were successful. At the end of six years, pasireotide was started. At the third month of treatment, biochemical control was achieved. Pasireotide may be a treatment option for some patients with acromegaly that are inadequately controlled by first generation SSRAs.

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1. Melmed S. Acromegaly. N Eng J Med. 2006;355:2558-73.

2. Holdaway IM, Bolland MJ, Gamble GD. A meta-analysis of the effect of lowering serum levels of GH and IGF-1 on mortality in acromegaly. Eur J Endocrinol. 2008;159:89-95.

3. Clayton RN, Stewart PM, Shalet SM, et al. Pituitary surgery for acromegaly. Should be done by specialists. BMJ. 1999;319:588-9.

4. Mc Cabe J, Ayuk J, Sherlock M. Treatment factors that influence mortality in acromegaly. Neuroendocrinology. 2016;103:66-74.

5. Colao A, Auriemma RS, Pivonello R, et al. Interpreting biochemical control response rates with first-generation somatostatin analogues in acromegaly. Pituitary. 2016;19:235-47.

6. Marazuela M, Ramos-Leví AM, de Borges Souza P, et al. Is receptor profiling useful for predicting pituitary therapy? Eur J Endocrinol. 2018;179:15-25.

7. Melmed S, Bronstein MD, Chanson P, et al. A Consensus Statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol. 2018;14:552-61.

8. Howlett TA, Willis D, Walker G, et al. UK Acromegaly Register Study Group (UKAR-3). Control of growth hormone and IGF1 in patients with acromegaly in the UK: Responses to medical treatment with somatostatin analogues and dopamine agonists. Clin Endocrinol. 2013;79:689-99.

9. Samson SL. Pasireotide in Acromegaly: An overwiew of current mechanistic and clinical data. Neuroendocrinology. 2015;102:8-17.

10. Lacovazzo D, Carlsen E, Lugli F, et al. Factors predicting pasireotide responsiveness in somatotroph pituitary adenomas resistant to first— generation somatostatin analogues:an immunohistochemical study. European J Of Endocrinol. 2016;174:241-50.

11. Paragliola RM, Corsello SM, Salvatori R. Somatostatin receptor ligands in acromegaly :clinical response and factors predicting resistance. Pituitary. 2017;20:109-15.

12. Gadelha M, Bronstein MD, Brue T, et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): A randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2014;2:875-84.

13. Schöfl C, Colao AM, Neggers SJCMM, et al. European observational study in patients with uncontrolled acromegaly who are being treated with long acting pasireotide: First interim analysis. In Proceedings of the Program of 20th European Congress of Endocrinology, Barcelona, Spain, 19–22 May 2018;56:8.

14. Muhammad A, Van der Lely AJ, Delhanty PJ, et al. Efficacy and Safety of Switching to Pasireotide in Patients With Acromegaly Controlled With Pegvisomant and First-Generation Somatostatin Analogues (PAPE Study). J Clin Endocrinol Metab. 2018;103:586-95.

15. Gadelha MR, Wildemberg LE, Bronstein MD, et al. Somatostatin receptor ligands in the treatment of acromegaly. Pituitary. 2017;20:100-8.