Analgesic effect of long-acting somatostatin receptor agonist pasireotide in a patient with acromegaly and intractable headaches

BMJ Case Rep. 2018 Jun 19:2018:bcr2017219686. doi: 10.1136/bcr-2017-219686.

Abstract

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.

Keywords: drugs: endocrine system; headache (including migraines); pituitary disorders.

Publication types

  • Case Reports

MeSH terms

  • Acromegaly / complications
  • Acromegaly / drug therapy*
  • Female
  • Headache Disorders / drug therapy*
  • Headache Disorders / etiology
  • Human Growth Hormone / analysis
  • Humans
  • Insulin-Like Growth Factor I / analysis
  • Magnetic Resonance Imaging
  • Pituitary Neoplasms / complications
  • Pituitary Neoplasms / diagnostic imaging
  • Somatostatin / administration & dosage
  • Somatostatin / analogs & derivatives*
  • Somatostatin / pharmacology
  • Young Adult

Substances

  • Human Growth Hormone
  • Somatostatin
  • Insulin-Like Growth Factor I
  • pasireotide

Associated data

  • ClinicalTrials.gov/NCT01995734