Acromegaly can be cured by first-line pasireotide treatment?
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RESEARCH LETTER
Acromegaly can be cured by first-line pasireotide treatment? Sabrina Chiloiro1 Antonella Giampietro1 Antonio Bianchi1 Tommaso Tartaglione2 Chiara Bima1 Maria Gabriella Vita3 Maurizio Spinello4 Alfredo Pontecorvi1 Laura De Marinis1 ●
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Received: 6 September 2018 / Accepted: 13 February 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Pasireotide long-acting release (LAR) is a new generation long-acting somatostatin multi-receptor ligand, with an increased affinity for the five subtypes of the somatostatin receptor compared with first-generation somatostatin analogues (SSAs) [1]. Several studies have proven the efficacy of pasireotide LAR in reaching the biochemical control of acromegaly, both in medically naive and in patients resistant to conventional SSA [2–7]. We report here the case of a patient with acromegaly who was successfully treated with first-line pasireotide LAR.
Case report The patient’s medical history concerning the present case started on April 2009, at the age of 68 years, when the patient underwent urologic specialist evaluation for a recent occurrence of nocturia, pollakiuria, and dysuria. The specific prostate antigen (PSA) value was normal. However, the ultrasound evaluation of the prostatic gland showed an increased volume of the gland with a transversal diameter of 57 mm. The patient was encouraged by the urologists to undergo an endocrine evaluation. In September 2009, the patient was admitted at our Unit of Pituitary Disease. The patient did not suffer from any specific symptoms (weight: 75 kg; body mass index: 25 kg/m2). His face and habitus were suggestive of acromegaly. The patient underwent a
* Laura De Marinis [email protected] 1
Pituitary Unit, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
2
Department of Radiology, Istituto Dermopatico dell’Immacolata, Rome and Università Cattolica del Sacro Cuore, Rome, Italy
3
Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
4
Novartis Farma SpA, Origgio, Italy
basal pituitary hormonal test that documented an impaired secretion of growth hormone (GH) and insulin-like growth factor-1 (IGF-I), 8.7 ng/ml and 584 ng/ml (age and genderadjusted range: 80–200 ng/ml), respectively. During suppression test with glucose (75 g), GH nadir during oral glucose tolerance test (OGTT) was 8.14 ng/ml. None pituitary deficits occurred. Remaining pituitary function was conserved. Contrasted pituitary and brain magnetic resonance (MR) showed the presence of a 7-mm nodular expansive formation in the right half of the pituitary, compatible with a small pituitary adenoma (Fig. 1a, b). Consequently, the diagnosis of acromegaly due to the presence of a pituitary adenoma was conducted. The patient underwent a clinical evaluation for acromegaly-associated comorbidities, and was documented with multinodular thyroid goiter, liver steatosis, hip os
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