Pituitary · 2025
Pasireotide as first line medical therapy for selected patients with acromegaly.
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Olarescu Nicoleta C, Jørgensen Anders P, Atai Shahriar, Wiedmann Markus K H, Dahlberg Daniel, Bollerslev Jens, Heck Ansgar
Аннотация
BACKGROUND AND PURPOSE: In acromegaly, growth hormone (GH) excess and pituitary tumours are typically managed through transsphenoidal surgery, often in combination with somatostatin receptor ligands (SRLs) given either before or following surgery. Although first-generation SRLs (lanreotide and octreotide) are efficacious in many patients, some exhibit resistance.
METHODS: We present the efficacy of the second-generation SRL, pasireotide, in six patients anticipated to be resistant to first-generation SRLs. The patients had large, hyperintense tumors on T2-weighted MRI and sparse granulation pattern by histology.
RESULTS: Over three to eight months, pasireotide reduced tumour volume in all patients and improved GH and IGF-1 levels. Visual field defects normalised. Despite hyperglycemia, requiring antidiabetic treatment in two patients, pasireotide proved effective as a first pharmacological therapy.
CONCLUSION: This series supports the use of pasireotide for rapid tumour control and GH reduction, in selected patients with complex and large tumours, likely to be resistant to first-generation SRLs. This approach expands the therapeutic options for managing the most challenging cases enhancing the potential for other subsequent treatment modalities.
METHODS: We present the efficacy of the second-generation SRL, pasireotide, in six patients anticipated to be resistant to first-generation SRLs. The patients had large, hyperintense tumors on T2-weighted MRI and sparse granulation pattern by histology.
RESULTS: Over three to eight months, pasireotide reduced tumour volume in all patients and improved GH and IGF-1 levels. Visual field defects normalised. Despite hyperglycemia, requiring antidiabetic treatment in two patients, pasireotide proved effective as a first pharmacological therapy.
CONCLUSION: This series supports the use of pasireotide for rapid tumour control and GH reduction, in selected patients with complex and large tumours, likely to be resistant to first-generation SRLs. This approach expands the therapeutic options for managing the most challenging cases enhancing the potential for other subsequent treatment modalities.