Beyond biochemical control: headache resolution with pasireotide in a patient with acromegaly and residual tumor.
Pasireotide may help normalize IGF-1 levels and resolve headaches in patients with treatment-resistant acromegaly, but this is based on a single case report.
Where it sits
this study against the rest of the pasireotide corpusSummary and findings
A 40-year-old woman with acromegaly and a growth hormone and prolactin co-secreting pituitary macroadenoma experienced persistent elevated IGF-1 levels and severe headaches despite multiple treatments. After initiating pasireotide long-acting release, IGF-1 levels normalized, and headaches resolved. The case highlights pasireotide's potential role in treatment-resistant acromegaly.
Abstract
Acromegaly management is particularly challenging when pituitary adenomas invade the cavernous sinus, limiting the likelihood of complete surgical resection. We describe a case of a 40-year-old woman with acromegaly caused by a growth hormone and prolactin co-secreting pituitary macroadenoma with bilateral cavernous sinus invasion and severe, frequent headache. Despite transsphenoidal surgery, radiotherapy, and sequential medical therapy with octreotide, cabergoline, and pegvisomant over 3 years, insulin-like growth factor 1 (IGF-1) levels remained elevated and headache burden persisted. Initiation of pasireotide long-acting release was followed by rapid normalization of IGF-1 levels and complete resolution of headache, with improvement in other acromegaly related symptoms. This case supports the potential role of pasireotide in selected patients with biochemically and clinically treatment-resistant acromegaly and contributes to the growing real-world evidence regarding its use in patients with residual disease in surgically challenging locations.
Background
Not reported in abstract.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Limitations
Not reported in abstract.