Endocrine Abstracts

Introduction: Medical treatment of acromegaly with somatostatin analogues (SAs) has been used for a long time and is a well-established treatment in cases where surgery, which is the first-line treatment, is impossible or inadequate. We report a case of acromegaly under control after initiation of Lanreotide.

Observation: Patient aged 59 years, referred for acromegaloid dysmorphic syndrome initially with tumor syndrome with IGF1 workup at 729 ng/mL (normal: 59 to 206) and at MRI presence of a pituitary macroadenoma with sphenoidal extension of "32 × 32 × 26 mm, enveloping the right carotid artery. In the workup, an unbalanced diabetes with HbA1c at 12% under insulin, a carpal tunnel syndrome confirmed by EMG, a sleep apnea syndrome and a colonic diverticulosis without any sign of malignancy, the rest is unremarkable. The patient underwent two neurosurgical operations. The last follow-up MRI showed no tumor residue contrasting with a still elevated IGF1 of 624 ng/ml. He was put on Lanreotide at a dose of 120 mg/mol. The evolution under treatment is marked by clinical improvement, decrease of the IGF1 level to 173 ng/mL with a control MRI still without tumor residue, as well as the balancing of diabetes with HbA1c at 6.5% under RHD, a regression of the carpal tunnel syndrome.

Discussion and conclusion: Although surgical treatment is the first line of treatment in acromegaly, treatment with SA is well established and is mainly used after insufficient surgical intervention, but also as primary medical treatment when surgery cannot be performed and finally when IGF1 concentration remains high despite the absence of tumor residue.