Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues. (21st November 2016)

• Record Type: Journal Article
• Authors: Alvarez-Escola, Cristina; Cardenas-Salas, Jersy
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2016)
• Publication Date: 2016-11-21
• Subjects: Adult -- Female -- White -- Spain; Pituitary -- Neuroendocrinology -- IGF1 -- GH -- Acromegaly -- Pituitary adenoma; Macroglossia -- Prognathism -- Frontal bossing -- Facies – abnormal -- Hands – enlargement -- Feet – increased size -- MRI -- IGF1 -- GH -- Haemoglobin A1c -- Glucose (blood, fasting) -- Glucose tolerance (oral) -- Visual field assessment -- Resection of tumour -- Transsphenoidal surgery -- Lanreotide -- Somatostatin analogues -- Calcium -- Captopril -- Angiotensin–converting enzyme inhibitors; Gastroenterology; Unusual effects of medical treatment -- November -- 2016; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-16-0092
• Languages: English
• ISSNs: 2052-0573

Abstract

Summary: In patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH) and insulin-like growth factor (IGF1) levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status). The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission. Learning points: The probability of disease recurrence is high after discontinuation of treatment with somatostatin analogues. Current data indicate that remission after treatment discontinuation may be more likely in patients with low GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on MRI, and/or in patients receiving prolonged treatment. This case report suggests that prolonged treatment with somatostatin analogues can be curative in carefully selected patients.