A persistent headache in acromegalic patient: the positive result of combination therapy with pasireotide LAR, pegvisomant and cabergoline

Penelope Giambo; Antonella Giampietro; Mattogno Pier Paolo; Ciro Mazzarella; Liverana Lauretti; Marinis Laura De; Francesco Doglietto; Antonio Bianchi; Alfredo Pontecorvi; Sabrina Chiloiro

doi:10.1530/endoabs.110.EP1254

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Endocrine Abstracts (2025) 110 EP1254 | DOI: 10.1530/endoabs.110.EP1254

ECEESPE2025 ePoster Presentations Pituitary, Neuroendocrinology and Puberty (220 abstracts)

A persistent headache in acromegalic patient: the positive result of combination therapy with pasireotide LAR, pegvisomant and cabergoline

Penelope Giambò ^1,2 , Antonella Giampietro ^1,2 , Pier Paolo Mattogno ^1,2 , Ciro Mazzarella ^1,2 , Liverana Lauretti ^1,2 , Laura De Marinis ^1,2 , Francesco Doglietto ^1,2 , Antonio Bianchi ^1,2 , Alfredo Pontecorvi ^1,2 & Sabrina Chiloiro ^1,2

Author affiliations

¹Policlinico Universitario Agostino Gemelli, Rome, Italy; ²Università Cattolica del Sacro Cuore, Rome, Italy

JOINT2517

Acromegaly is a rare condition characterized by the excessive exposure to GH and IGF-1 due to a pituitary adenoma in most of the cases. The disease is associated with numerous symptoms including headache, which is frequently difficult to manage. We aim to report the clinical history of a young woman who received the diagnosis of acromegaly when she was 11 years-old and started to refer headache, localized in the right frontal and orbital area, associated with nausea and emesis and finally got hospitalized in March 2011 because of a tonic-clonic seizure. The preliminary investigations included cerebral CT scan and RM which showed a voluminous lesion of the sellar and suprasellar region, located behind optic chiasm which compressed the third ventricle with consequent hydrocephalus and shifting of the midline, and hormonal dosage (IGF-I: 1008 ng/ml; PRL 3861 ng/ml with no macroprolactin). After the execution of an endoscopic septostomy and right ventriculoperitoneal shunt, the case was collectively discussed and considering the elevated risk related to neurosurgery, the patient started cabergoline, lanreotide ATG and pegvisomant first, pasireotide LAR as only therapy secondly and then shifted again to the first combination therapy. Despite the partial biochemical control, in consideration to the low lesion shrinkage, in December 2012 a partial resection of the macroadenoma was obtained. Over the years, the patient continued the medical therapy with lanreotide, cabergoline and pegvisomant in combination with good biochemical control and stability of the residual adenoma. In 2022, the patient started to refer headache that couldn’t be attributed to acromegaly progression nor ventriculoperitoneal shunt malfunctioning. In December 2023, lanreotide was substituted with pasireotide. In the last check-ups, the patient referred optimal control of headache by the combination therapy cabergoline, pegvisomant and pasireotide LAR. Pasireotide is known to be able to improve symptoms not sufficiently controlled by fg-SRLs and it can be used as monotherapy or in combination therapy in patients with severe headache not responsive to first-generation SRL therapy, as reported in several studies. Our case report enforces knowledge about pasireotide benefits in headache treatment.