Successful Primary Medical Therapy with Somatostatin Receptor Ligand in Acromegaly with Thyroid Cancer

Shalini Sree Dharan, Nor Azmi Kamaruddin

Abstract

Acromegaly is a rare disease with an annual incidence of 3 to 4 cases in a million.[1] Diagnosis is often delayed due to the slow progression of the disease. Persistent elevation of growth hormone (GH) in acromegaly causes a reduction in life expectancy by 10 years. Aside from multiple cardiovascular, respiratory and metabolic co-morbidities, it has also been proven to cause an increased incidence of cancer. The main treatment of acromegaly is surgical excision of the functioning pituitary adenoma. Multiple comorbidities, including obstructive sleep apnea (OSA), left ventricular hypertrophy (LVH) and soft tissue swelling, make surgery complicated, if not impossible. Medical therapy to reduce co-morbidities may be indicated in certain situations. Somatostatin receptor ligands (SRL) are able to reduce, and possibly normalize, IGF-1 levels.[2] Reduction of insulin-like growth factor-1 (IGF-1), the main mediator of GH, is able to resolve headache, sweating, fatigue and soft tissue swelling, and also reduce ventricular hypertrophy. This case report illustrates the successful use of the SRL octreotide LAR in treating acromegaly. It also confirms the observation from several case series that thyroid cancer is the most common malignancy in acromegaly.

Keywords

acromegaly, somatostatin receptor ligands, octreotide LAR, papillary thyroid cancer

Full Text:

Abstract HTML

References

Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: Epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102-52. PMID: 14769829. https://doi.org/ 10.1210/er.2002-0022.

Ben-Shlomo A, Melmed S. Clinical review 154: The role of pharmacotherapy in perioperative management of patients with acromegaly. J Clin Endocrinol Metab. 2003;88(3):963-8. https://doi.org/10.1210/jc.2002-020072.

Ezzat S, Snyder PJ, Young WF, et al. Octreotide treatment of acromegaly: A randomized, multicenter study. Ann Intern Med. 1992;117(9):711-8. PMID: 1416572. https://doi.org/10.7326/0003-4819-117-9-711.

Bevan JS, Atkin SL, Atkinson AB, et al. Primary medical therapy for acromegaly: An open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size. J Clin Endocrinol Metab. 2002;87(10):4554-63. PMID: 12364434. https://doi.org/10.1210/jc.2001-012012.

Melmed S, Casanueva F, Cavagnini F, et al. Consensus statement: Medical management of acromegaly. Eur J Endocrinol. 2005;153(6):737-40. PMID: 16322377. https://doi.org/10.1530/eje.1.02036.

Shen M, Shou X, Wang Y, et al. Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: A prospective randomized study. Endocr J. 2010;57(12):1035-44. PMID: 21099129.

Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly. J Neurosurg. 1998;89(3):353-8. PMID: 9724106. https://doi.org/10.3171/jns.1998.89.3.0353.

Orme SM, McNally RJ, Cartwright RA, Belchetz PE. Mortality and cancer incidence in acromegaly: A retrospective cohort study. United Kingdom Acromegaly Study Group. J Clin Endocrinol Metab. 1998;83(8):2730-4. PMID: 9709939. https://doi.org/10.1210/jcem.83.8.5007.

Colao A, Lombardi G. Growth hormone and prolactin excess. Lancet. 1998;352(9138):1455-61. PMID: 9808008. https://doi.org/10.1016/S0140-6736(98)03356-X.

Katznelson L, Laws ER Jr, Melmed S, et al. Acromegaly: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(11):3933-51. PMID: 25356808. https://doi.org/10.1210/jc.2014-2700.

Dagdelen S, Cinar N, Erbas T. Increased thyroid cancer risk in acromegaly. Pituitary. 2014;17(4):299-306. PMID: 23836362. https://doi.org/10.1007/s11102-013-0501-5.

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1-133. PMID: 26462967. PMCID: PMC4739132. https://doi.org 10.1089/thy.2015.0020.

Carlsen SM, Lund-Johansen M, Schreiner T, et al. Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab. 2008;93(8):2984-90. PMID: 18492760. https://doi.org/10.1210/jc.2008-0315.