A 22-year-old woman presented with worsening vision loss and headaches. A diagnosis of acromegaly was confirmed after detection of an invasive pituitary macroadenoma and biochemical testing. Despite two attempts of surgical debulking of the tumour and administration of long-acting octreotide and cabergoline, growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were uncontrolled. The patient experienced persistent headaches despite surgery, gamma knife radiation and ventriculoperitoneal shunt placement; she was then enrolled in the ACCESS trial (ClinicalTrials.gov identifier, NCT01995734). Pasireotide (Signifor; Signifor LAR) was initiated, which led to reduced GH and IGF-1 levels and resolution of her intractable headaches. This highlights the use of monthly pasireotide in resolving headaches and improved biochemical control in a patient with acromegaly. We postulate that the headaches improved due to an analgesic and/or anti-inflammatory effect mediated by somatostatin receptors targeted by pasireotide. This may represent an additional benefit of pasireotide and requires further investigation.
- pituitary disorders
- headache (including migraines)
- drugs: endocrine system
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Contributors CML was involved in conception of the article, data collection and interpretation, drafting and critical revision of the article as well as final approval of the version to be published. PLK was involved in conception of the article, data collection and interpretation, critical revision of the article as well as final approval of the version to be published.
Funding Novartis Pharmaceuticals Corporation.
Competing interests CML has received research support from Novartis for the ACCESS clinical trial. PLK has received grants for clinical trials from Cortendo, GlaxoSmithKline, MannKind, Merck, Novartis and Novo Nordisk.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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