Analgesic effect of long-acting somatostatin receptor agonist pasireotide in a patient with acromegaly and intractable headaches

Abstract

A 22-year-old woman presented with worsening vision loss and headaches. A diagnosis of acromegaly was confirmed after detection of an invasive pituitary macroadenoma and biochemical testing. Despite two attempts of surgical debulking of the tumour and administration of long-acting octreotide and cabergoline, growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels were uncontrolled. The patient experienced persistent headaches despite surgery, gamma knife radiation and ventriculoperitoneal shunt placement; she was then enrolled in the ACCESS trial (ClinicalTrials.gov identifier, NCT01995734). Pasireotide (Signifor; Signifor LAR) was initiated, which led to reduced GH and IGF-1 levels and resolution of her intractable headaches. This highlights the use of monthly pasireotide in resolving headaches and improved biochemical control in a patient with acromegaly. We postulate that the headaches improved due to an analgesic and/or anti-inflammatory effect mediated by somatostatin receptors targeted by pasireotide. This may represent an additional benefit of pasireotide and requires further investigation.

Keywords: drugs: endocrine system; headache (including migraines); pituitary disorders.

Conflict of interest statement

Competing interests: CML has received research support from Novartis for the ACCESS clinical trial. PLK has received grants for clinical trials from Cortendo, GlaxoSmithKline, MannKind, Merck, Novartis and Novo Nordisk.

© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1

MRI of pituitary tumour. (A) T1-FLAIR coronal post contrast from 3 March 2011 (at initial diagnosis). (B) T1 coronal post contrast from 4 October 2015.

Figure 2

Patient timeline: GH and IGF-1 levels through the course of treatment with long-acting pasireotide. GH, growth hormone; IGF-1, insulin-like growth factor 1; VP, ventriculoperitoneal.