Endocrine Abstracts

Pasireotide long-acting release (LAR) is a multireceptor-targeted somatostatin receptor ligand approved for treatment of patients with acromegaly. In some clinical reports, pasireotide LAR has been shown to regulate biochemical outcomes more than other somatostatin receptor ligands. However, hyperglycemia was frequently observed in pasireotide LAR treated patients with acromegaly. Three patients were treated with pasireotide LAR to regulated biochemical parameters of acromegaly. They had an elevated levels of insulin-like growth factor 1 (IGF1) and growth hormone (GH) after surgery of pituitary tumor and medication treatment of octreotide LAR. All three had consistently high level of IGF1 and GH for several years. After 3 months of pasireotide LAR treatment, IGF1 level tended to decrease compared to the previous clinical outcomes. In first case, IGF1 and GH before pasireotide LAR were 369.41 ng/ml and 6.28 ng/ml. After 3 months of pasireotide LAR, IGF1 and GH were decreased to 187.56 ng/ml and 3.41 ng/ml. In second and third cases, levels of those were 409.98 ng/ml, 341.7 ng/ml and 4.48 ng/ml, 5.14 ng/ml to 167.07 ng/ml, 178.18 ng/ml and 2.27 ng/m, 1.00 ng/ml. But levels of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) increased. FPG and HbA1c were elevated 2-fold from baseline in 2 patients with diabetes mellitus (DM) treated oral hypoglycemic agents (OHAs); FPG 183 mg/mL to 312 mg/mL and HbA1c 6.2% to 11.9% in first case. Another, FPG 110 mg/mL to 265 mg/mL and HbA1c 6.3% to 12.6%. The patient with previously normal glucose tolerance was newly diagnosed DM; FPG 85 mg/mL to 461 mg/mL and HbA1c 6.0% to 12.6%. These clinical cases suggest that the effect and safety of the pasireotide LAR should be considered in patients with acromegaly. Especially, pasireotide LAR-induced hyperglycemia should be carefully observed and treatment of hyperglycemia should be started at an appropriate time.