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Daly, A.F.* ; Rostomyan, L.* ; Betea, D.* ; Bonneville, J.F.* ; Villa, C.* ; Pellegata, N.S. ; Waser, B.* ; Reubi, J.C.* ; Waeber Stephan, C.* ; Christ, E.* ; Beckers, A.*

Aip-mutated acromegaly resistant to first-generation somatostatin analogs: Long-term control with pasireotide lar in two patients.

Endocr. Connect. 8, 367–377 (2019)

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Acromegaly is a rare disease due to chronic excess growth hormone (GH) and IGF-1. Aryl hydrocarbon receptor interacting protein (AIP) mutations are associated with an aggressive, inheritable form of acromegaly that responds poorly to SST2-specific somatostatin analogs (SSA). The role of pasireotide, an SSA with affinity for multiple SSTs, in patients with AIP mutations has not been reported. We studied two AIP mutation positive acromegaly patients with early-onset, invasive macroadenomas and inoperable residues after neurosurgery. Patient 1 came from a FIPA kindred and had uncontrolled GH/IGF-1 throughout 10 years of octreotide/lanreotide treatment. When switched to pasireotide LAR, he rapidly experienced hormonal control which was associated with marked regression of his tumor residue. Pasireotide LAR was stopped after >10 years due to low IGF-1 and he maintained hormonal control without tumor regrowth for >18 months off pasireotide LAR. Patient 2 had a pituitary adenoma diagnosed when aged 17 that was not cured by surgery. Chronic pasireotide LAR therapy produced hormonal control and marked tumor shrinkage but control was lost when switched to octreotide. Tumor immunohistochemistry showed absent AIP and SST2 staining and positive SST5. Her AIP mutation positive sister developed a 2.5 cm follicular thyroid carcinoma aged 21 with tumoral loss of heterozygosity at the AIP locus and absent AIP staining. Patients 1 and 2 required multi-modal therapy to control diabetes. On stopping pasireotide LAR after >10 years of treatment, Patient 1’s glucose metabolism returned to baseline levels. Long-term pasireotide LAR therapy can be beneficial in some AIP mutation positive acromegaly patients that are resistant to first-generation SSA.

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Publication type Article: Journal article

Document type Scientific Article

Corresponding Author

Keywords Acromegaly ; Aip ; Fipa ; Lanreotide ; Octreotide ; Pasireotide ; Pituitary Adenoma ; Resistant ; Somatostatin Analog ; Thyroid Cancer; Isolated Pituitary-adenomas; Interacting Protein; Thyroid-tumors; Octreotide Lar; Expression; Mutations; Somatotropinomas; Gene; Prevalence; Gigantism

ISSN (print) / ISBN 2049-3614

e-ISSN 2049-3614

Journal Endocrine Connections

Quellenangaben Volume: 8, Issue: 4, Pages: 367–377

Publisher BioScientifica

Publishing Place Bristol

Non-patent literature Publications

Institute(s) Institute of Diabetes and Cancer (IDC)