The value of the somatostatin analogues in the treatment of acromegaly is well established. The experience on their efficacy in gigantism is limited involving the administration of octreotide. To our knowledge, no such cases treated by lanreotide have been reported.
An 18-year old student presented to the A&E with a month history of blurred vision and headaches. CT showed a suprasellar pituitary tumour with obstructive hydrocephalus. Emergency insertion of a VP shunt resulted in some symptomatic improvement. On further questioning, he mentioned tiredness, night sweats and decreased frequency of shaving during the last 6 months. He had prognathism, large feet/hands and looked hypogonadal. Height was 194 cm (mid-parental 178) and span 193 cm. Further tests suggested acromegaly [IGF-I 137 nmol/l (16118), random GH 184 mU/L]. The MRI revealed pituitary macroadenoma with extension into the sphenoid/cavernous sinuses, compression of the optic chiasm and extension into the 3rd ventricular floor. PRL was 634 mU/L (45375), he had hypogonadotrophic hypogonadism, normal short synacthen test and thyroid hormones. Bone age was 15 years. For the next 5 months, he was offered lanreotide (Somatuline Autogel) (cabergoline was added at the 4th month) resulting in marked improvement in the GH hypersecretion (mean GH in GHDC 16.31 mU/l and IGF-1 59.1 nmol/l) and vision. There was also significant tumour shrinkage, with the ventricles returning to normal and the extensions of the adenoma being less profound. No side effects were recorded. Following surgical resection, the nadir GH in OGTT was 1.93 mU/L, the mean GH 8.0 mU/L and the IGF-I 75.5 nmol/l.
Somatotroph adenomas causing gigantism may be aggressive and difficult to treat. This is the first reported case of gigantism offered lanreotide pre-operatively with biochemical and visual improvement, significant tumour shrinkage and no adverse effects; lanreotide can be part of the multimodality therapeutic approach in gigantism.