Acromegalic patients’ expected survival rate and quality of life are worse than those of the healthy population. This is due to delayed diagnosis and often persistent post-surgical residual hormonal activity of the disease. Therefore, early, effective and individualized endocrine treatment and care are especially important. Our female patient was born in 1965, and has required therapy for tension-type headaches since 2008. In 2012, sella MR examination confirmed a pituitary macroadenoma of 13 mm, which was completely removed by transsphenoidal neurosurgery. Histological examination verified a somatotroph adenoma. Based on the results of post-operative oral glucose load, biochemically active acromegaly was detected, along with a negative sella MR image, thus dopamine agonist treatment was started. Later, due to rising insulin-like growth factor 1 levels and increasing headaches, she was switched to first-generation somatostatin receptor ligand (SRL) therapy. Her developing diabetes mellitus required first biguanide, then later on insulin therapy. Due to progressive complaints, growth hormone-receptor antagonist treatment was started, which resulted in partial disease control. The persistent, severe headaches significantly worsened her quality of life. Therefore, after a decade of different therapeutic approaches, despite the existing diabetes mellitus, second-generation SRL treatment was advised. On pasireotide therapy, her headache stopped immediately, and complete disease control was achieved. The retrospective somatostatin receptor (SSTR) subtype evaluation of the adenoma confirmed dominant SSTR5 expression. Pasireotide could be an optimal choice of first-line therapy in cases of acromegaly complicated by diabetes mellitus, if the adenoma has dominant SSTR5 expression. Orv Hetil. 2024; 165(40): 1587–1593.
Az acromegaliás betegek várható túlélése, életminősége rosszabb, mint az egészséges populációé. Ennek hátterében a diagnózis késése és a műtét után is sokszor megmaradó acromegalia-aktivitás áll. Így esetükben különösen fontos a gyors, hatékony és egyénre szabott endokrinológiai kezelés és gondozás. 1965-ös születésű nőbetegünket 2008 óta gondozták tenziós jellegű fejfájás miatt. 2012-ben sella-MR-vizsgálat 13 mm-es hypophysis-macroadenomát igazolt, melynek teljes, transsphenoidalis műtéti eltávolítása megtörtént. A szövettani vizsgálat somatrotrop adenomát mutatott. Posztoperatív orális glükóztolerancia-teszt során biokémiailag aktív acromegaliát észleltünk negatív sella-MR-kép mellett, így dopaminagonista kezelés indult, majd az inzulinszerű növekedési faktor-1 emelkedő szintje és fokozódó fejfájás miatt első generációs szomatosztatinreceptorligand (SRL)-kezelésre tértünk át. Új keletű cukorbetegség miatt a beteg biguanid-, majd izulinterápiát igényelt. Progrediáló panaszok miatt növekedésihormonreceptor-antagonista kezelésre váltottunk, mely részleges betegségkontrollt eredményezett, és nem változtak a páciens életminőségét jelentősen rontó fejfájásos panaszok sem. Ezért egy évtizednyi terápiás próbálkozás után a fennálló diabetes mellitus ellenére második generációs SRL-kezelés mellett döntöttünk, mely a fejfájást azonnal megszüntette, és az addig aktív acromegaliát kontrollálta. A szomatosztatin-receptor (SSTR) altípusának utólagos vizsgálata domináns SSTR5-expressziót igazolt. Diabetes mellitusszal szövődött acromegalia esetén is lehet optimális terápia a pazireotid, amennyiben a daganat SSTR5-expressziót mutat. Orv Hetil. 2024; 165(40): 1587–1593.
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