Pasireotide, a multireceptor-targeted somatostatin analogue, was approved for the treatment of acromegaly, after being studied in two large, randomised, multi-center clinical trials. We reported the history of a 76 years old man affected by acromegaly, treated with Pasireotide long acting release (LAR) as first line therapy. Acromegaly was diagnosed in 2009, as the result of endocrinological investigation suggested by altered facial appearance and macroglossia. Hormonal assays demonstrated high levels of IGF1 (584 ng/ml) and GH (8.7 ng/ml), without any suppression of GH at oral glucose tolerance test. Patient consequently underwent brain magnetic resonance (MRI), with the finding of a 7 mm expansive formation of the right half adenohypophysis, suggestive for pituitary microadenoma. Patient, in November 2009, was enrolled in CSOM230C2305 study and was treated with Pasireotide LAR at blided dosage, with biochemical control of disease and progressive reduction of the pituitary adenoma volume. In May 2016, following the onset of dyspnea, dysphagia and dysphonia, patient was diagnosed with anti-MuSK-positive myasthenia gravis, treated with apheresis and steroid therapy, currently in good control. In this period, in according to the detection of very low level of IGF1 and in consideration of concomitant diagnosis of myasthenia gravis, therapy with Pasireotide LAR was discontinued and patient continued follow-up. The last brain MRI, performed in May 2016, documented the stability in size and morphology of the known pituitary microadenoma. Eight months later, in January 2017, patient is actually in remission, with IGF1 in the normal reference range for age and gender (196 ng/ml) and GH <2.5 ng/ml (0.5 ng/ml). This clinical case shows the efficacy of Pasireotide in gaining biochemical control of acromegaly, factor that is primarily implicated in the reduction of disease morbidity and mortality.
20 May 2017 - 23 May 2017