Tirzepatide for pasireotide-induced hyperglycemia in a GH/TSH-producing pituitary adenoma/PitNET: a case report and literature review.
Tirzepatide may help manage hyperglycemia in patients treated with pasireotide, as evidenced by a decrease in HbA1c from 7.7% to 6.3%. Further research is needed to confirm these findings.
Where it sits
this study against the rest of the pasireotide corpusSummary and findings
This case report describes the use of once-weekly subcutaneous tirzepatide in a 48-year-old woman with pasireotide-induced hyperglycemia. The patient's HbA1c level decreased from 7.7% to 6.3% after switching to tirzepatide. The report highlights the need for further studies to establish treatment strategies for this condition.
Abstract
Pasireotide, a somatostatin analog with high affinity for somatostatin receptor 5 (SSTR5), is frequently used to treat residual or recurrent pituitary adenomas, but it often induces hyperglycemia by suppressing glucagon-like peptide-1 (GLP-1) secretion. Although GLP-1 receptor agonists (GLP-1RAs) have been reported to be effective for pasireotide-induced hyperglycemia, no established treatment strategy currently exists. The present report describes the first documented use of once-weekly subcutaneous tirzepatide in a patient with pasireotide-induced hyperglycemia that remained inadequately controlled despite oral GLP-1RA therapy. A 48-year-old woman without a history of glucose intolerance was diagnosed with a GH/TSH-producing pituitary adenoma/PitNET. Transsphenoidal surgery was performed, followed by initiation of pasireotide for the residual tumor. Subsequently, the patient developed progressive hyperglycemia, with the hemoglobin A1c (HbA1c) level increasing from 6.5% to 7.7%. Oral sitagliptin and semaglutide were sequentially introduced; however, glycemic control remained suboptimal. Upon switching to once-weekly subcutaneous tirzepatide, the HbA1c level decreased markedly from 7.7% to 6.3%, along with an improvement in random blood glucose levels. In conclusion, once-weekly subcutaneous tirzepatide may be a therapeutic option for selected patients with pasireotide-induced hyperglycemia. However, further studies are needed to determine whether its effects differ from those of intensified GLP-1RA therapy.
Background
Pasireotide is commonly used for treating pituitary adenomas but can induce hyperglycemia by suppressing GLP-1 secretion. Prior reports suggest GLP-1 receptor agonists may help manage this hyperglycemia, but no standardized treatment exists. This study is significant as it documents the first use of tirzepatide in this context, potentially offering a new management option.
Methods
This is a case report involving a 48-year-old woman diagnosed with a GH/TSH-producing pituitary adenoma. Following transsphenoidal surgery, pasireotide was initiated, leading to hyperglycemia. The patient received oral GLP-1RAs sequentially before switching to once-weekly subcutaneous tirzepatide.
Results
The primary observation was a decrease in HbA1c from 7.7% to 6.3% after the introduction of tirzepatide. Specific p-values and confidence intervals were not reported. Random blood glucose levels also improved, but exact values were not provided.
Interpretation
The findings suggest that tirzepatide may be effective in managing pasireotide-induced hyperglycemia, but the clinical significance of the HbA1c reduction needs further exploration. The small sample size and nature of the case report limit the generalizability of the results. Future studies should compare tirzepatide's effects to other GLP-1RAs to establish its relative efficacy.
Key findings
- HbA1c increased from 6.5% to 7.7% after pasireotide initiation.
- HbA1c decreased from 7.7% to 6.3% after switching to tirzepatide.
Limitations
- Single case report with n=1.
- No control group for comparison.
- Short duration of follow-up.
- No statistical analysis provided.