Endocrine Abstracts

Objective: Acromegaly is caused by a growth hormone (GH)-secreting pituitary tumor and its signs are linked to increasedGH-dependent hepatic insulin-like growth factor I (IGF-I) synthesis. A eucaloric very low-carbohydrate ketogenic diet (euVLCK; < 50 g/day) induces ketosis and reduces portal insulin concentrations, which down-regulate hepatic GH receptors and reduce IGF-I synthesis. Somatostatin receptor ligands (SRLs) reduce GH secretion by the pituitary tumor,resul...

Background: In the core phase of the PAPE study until 24 weeks we have shown that switching to pasireotide LAR (PAS-LAR) in well-controlled acromegaly patients receiving combination therapy of somatostatin analogues and pegvisomant (PEGV), normalizes IGF1 levels in the majority of patients. PAS-LAR induced a significant PEGV sparing effect, but this was at the expense of a higher incidence of diabetes. This extension study until 48-weeks assesses the efficacy, safety and quali...

Context: Transsphenoidal surgery (TSS) is the primary treatment of choice in acromegaly. It is important to identify patients in whom surgical cure is not attainable at an early stage, both to inform patients on expected treatment outcome and to select those who are more likely to need additional therapy.Objective: To identify predictors for remission and relapse after TSS in acromegaly.Design: Retrospective study in three large te...

Background: The response to first-generation long-acting somatostatin analogues (LA-SSA) treatment in acromegaly depends on the expression of the somatostatin receptor (SSTR) subtypes. In contrast to octreotide and lanreotide which preferentially bind to SSTR2, pasireotide targets multiple SSTRs, with the highest binding affinity for SSTR5. It has previously been suggested that SSTR5 expression could predict the response to pasireotide LAR (PAS-LAR) treatment in acromegaly.</p...

Background: Previous studies indicate that PAS-LAR can achieve control of insulin-like growth factor I (IGF-I) levels and may reduce tumor size, however a subset of acromegaly patients responds poorly. T2-signal intensity, somatostatin receptor (SST) subtype 2 and 5 expression, and the response to first-generation somatostatin receptor ligands (SRLs) are recognized predictors of therapy response. Valid prediction of the response to PAS-LAR can alter treatment stratification.</...

Background: Prolactinomas are the most frequent secreting pituitary adenomas encountered in the clinical setting. Cabergoline is considered the mainstay medical treatment and transsphenoidal surgery (TSS) is recommended for patients that are medically resistant to dopamine agonist therapy. Resistance to dopamine agonists is commonly defined as failure to normalize prolactin and less than 50% decrease in tumor diameter at a maximal labeled dose of 2.0 mg/week. Pasireotide LAR (...

Purpose: Although quality of life (QoL) is improved in patients with acromegaly after disease control, QoL correlates only weakly with traditional biomarkers. Our objective is to investigate a potential relation between the new serum biomarker soluble Klotho (sKlotho), GH and insulin-like growth factor 1 (IGF-1) levels and QoL.Methods: In this prospective cohort study, we investigated 54 acromegaly patients biochemically well-controlled on combination tr...

ContextGermline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) have been identified in patients with pituitary adenomas, most frequently presenting as somatotropinomas in the setting of familial isolated pituitary adenoma (FIPA). Our current understanding of AIP related tumorigenesis indicates that it leads to isolated pituitary adenomans, while other associated tumors have not typically been considered part of the...

Objective: MRI T2-signal intensity and somatostatin (SST) receptor expression are recognized predictors of therapy response in acromegaly. We investigate the relationship between these predictors and the hormonal and tumor responses to PAS-LAR therapy, and compare to first-generation somatostatin receptor ligands (SRLs) responsiveness.Methods: We included 45 acromegalics initially receiving SRLs, followed by a combination therapy including pegvisomant (P...