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
This case report describes a 40-year-old woman with acromegaly and a growth hormone and prolactin co-secreting pituitary macroadenoma. After multiple treatments, initiation of pasireotide long-acting release led to rapid normalization of insulin-like growth factor 1 (IGF-1) levels and complete resolution of headaches. The report highlights the potential role of pasireotide in treatment-resistant cases of 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
Acromegaly is often complicated by pituitary adenomas that invade surrounding structures, making treatment challenging. Previous treatments, including surgery and various medications, can fail to achieve biochemical control or alleviate symptoms. This case is significant as it explores the use of pasireotide in a patient with treatment-resistant acromegaly, contributing to the understanding of its potential benefits in complex cases.
Methods
This is a case report detailing the treatment of a single patient with acromegaly. The patient had a history of pituitary macroadenoma with cavernous sinus invasion and had previously received multiple treatments. The primary outcome was the normalization of IGF-1 levels and headache resolution following pasireotide therapy.
Results
The initiation of pasireotide long-acting release was followed by rapid normalization of IGF-1 levels and complete resolution of headache. Specific numeric values for IGF-1 levels or headache frequency were not provided.
Interpretation
The findings suggest that pasireotide may be beneficial in patients with acromegaly who have not responded to other treatments. However, the lack of quantitative data and the single-case nature of the report limit the ability to draw broader conclusions. The absence of a control group and reliance on subjective symptom reporting further complicate the interpretation of these results.
Key findings
- Rapid normalization of IGF-1 levels after pasireotide initiation.
- Complete resolution of headache after pasireotide initiation.
- Patient had undergone transsphenoidal surgery, radiotherapy, and sequential therapy over 3 years.
Limitations
- Single case report with no control group.
- Lack of quantitative data on IGF-1 levels and headache frequency.
- No long-term follow-up reported.