Endocrine Abstracts

Background: Headache often occurs as incapacitating symptom among the patients with acromegaly. GH involvement in the pathophysiologic mechanism and an analgesic effect of somatostatin analogues has been described, but the exact mechanism is not clear. Whether the pan somatostatine (sst)-receptor agonists are superior as concern the antinociceptive effect than the more selective ones is not evidenced.

Case report: A 21-year old woman, diagnosed with acromegaly, presented with visual disturbances and incapacitating headaches lasting for 8 months (MRI: pituitary macroadenoma with supra- and parasellar propagation). Several daily attacks of headache were resistant to high doses of pain-killers. Preoperative neuroendocrine values on oral contraceptives: elevated mean spontaneously GH and insulin-like growth factor (IGF1) (Table 1. apr-09); low-normal free T₄ (13.4 pmol/l (14–23 pmol/l)); low levels of FSH <0.2 IU/l and LH <0.1 IU/l; low-normal response to Synacthen test (peak cortisol: 904 nmol/l). After two surgeries in 2009, tumour size was significantly reduced. Different combinations and dose concepts of octreotide, sandostatin LAR and somavert were applied but IGF1 remained high and the headaches worsened. Pasireotide–pegvisomant combination was introduced with prompt marked headache-relief, persisting until few days before next injection. IGF1 normalized for the first time (Table 1. apr-11).

Conclusion: Pasireotide may have a superior antinociceptive effect, as compared to other somatostatin analogues. Very possibly pan-sst receptor agonists may be superior to selective sst2 ones regarding their antinociceptive effect, but further studies are needed to clarify this.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.