Inoperable Giant Growth Hormone-secreting Pituitary Adenoma: Radiological Aspects, Clinical Management and Pregnancy Outcome

Author(s): Franca Dicuonzo, Stefano Purciariello, Aurora De Marco, Edoardo Guastamacchia, Vicenzo Triggiani*.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets

Volume 19 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background and Objective: Giant pituitary adenomas (GPAs) are benign tumours with a diameter ≥ 4 cm [1]. They can cause symptoms and signs due to the possible hyper-secretion of one or more pituitary hormones, and involvement of the surrounding structures whereas the compression of the pituitary itself can lead to hypopituitarism.

Methods: We report on a young woman with acromegaly due to an inoperable giant GH-secreting pituitary adenoma extending to right cavernous sinus, right orbital cavity, ethmoid, right maxillary sinus, sphenoid sinus, clivus and right temporal fossa, in which medical treatment with Octreotide- LAR was able to promptly relieve headache and bilateral hemianopsia due to optic chiasm involvement, improve acromegaly symptoms and, over the time, control tumor expansion, improving fertility and therefore allowing the patient to become pregnant.

Results: Octreotide-LAR therapy was withdrawn during pregnancy and the patient did not experience complications and gave birth to a healthy son. On magnetic resonance, the size of the tumor at the end of pregnancy and in the subsequent follow up was not increased.

Conclusion: The history we report, therefore, confirms previous experiences reporting a possible favourable outcome of pregnancy in patients affected by acromegaly and adds further information about the behaviour of giant pituitary tumors in patients underwent pregnancy.

Keywords: Giant pituitary adenoma, growth hormone, acromegaly, octreotide-LAR, pregnancy.

[1]
Raverot, G.; Jouanneau, E.; Trouillas, J. Management of endocrine disease: Clinicopathological classification and molecular markers of pituitary tumours for personalized therapeutic strategies. Eur. J. Endocrinol., 2014, 170(4), R121-R132.
[2]
Blevins, L.S., Jr; Verity, D.K.; Allen, G. Aggressive pituitary tumors. Oncology (Williston Park), 1998, 12(9), 1307-1312.
[3]
Garibi, J.; Pomposo, I.; Villar, G.; Gaztambide, S. Giant pituitary adenomas: Clinical characteristics and surgical results. Br. J. Neurosurg., 2002, 16, 133-139.
[4]
Fleseriu, M. Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: A literature review. Pituitary, 2011, 14(2), 184-193.
[5]
Van Der Lely, A.J.; De Herder, W.W.; Lamberts, S.W. The role of radiotherapy in acromegaly. J. Clin. Endocrinol. Metab., 1997, 82, 3185-3186.
[6]
Jenkins, P.J.; Carson, M.N. Conventional pituitary irradiation is effective in lowering serum growth hormone and insulin-like- growth factor in patients with acromegaly. J. Clin. Endocrinol. Metab., 2006, 91, 1239-1245.
[7]
Gheorghiu, M.L. Updates in outcomes of stereotactic radiation therapy in acromegaly. Pituitary, 2017, 20(1), 154-168.
[8]
Shimon, I.; Jallad, R.S.; Fleseriu, M.; Yedinak, C.G.; Greenman, Y.; Bronstein, M.D. Giant GH-secreting pituitary adenomas: Management of rare and aggressive pituitary tumors. Eur. J. Endocrinol., 2015, 172(6), 707-713.
[9]
Weckbecker, G.; Lewis, I.; Albert, R. Opportunities in somatostatin research: Biological, chemical and therapeutic aspects. Nat. Rev. Drug Discov., 2003, 2, 999-1017.
[10]
Colao, A.; Auriemma, M.S.; Galdiero, M. Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin-like growth factor-I levels, tumor shrinkage, and cardiovascular disease: A prospective study. J. Clin. Endocrinol. Metab., 2009, 94, 3746-3756.
[11]
Melmed, S.; Colao, A.; Barkan, A. Guideline for acromegaly management: An update. J. Clin. Endocrinol. Metab., 2009, 94, 1509-1517.
[12]
Öberg, K.; Lamberts, S.W. Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: Past, present and future. Endocr. Relat. Cancer, 2016, 12, R551-R566.
[13]
Zhang, L.Y.; Deng, K.; Zhang, Y.; Yao, Y.; Zhu, H.J.; Jin, Z.M.; Pan, H. Treatment effects analysis of preoperative long-acting somatostatin analogs combined trans-sphenoidal endoscopic surgery for patients with growth hormone secreting pituitary macroadenomas. Zhonghua Yi Xue Za Zhi, 2017, 97(5), 375-379.
[14]
Anthony, L.; Freda, P.U. From somatostatin to octreotide LAR: Evolution of a somatostatin analogue. Curr. Med. Res. Opin., 2009, 25(12), 989-999.
[15]
Ben-Shlomo, A.; Melmed, S. Somatostatin agonists for treatment of acromegaly. Mol. Cell. Endocrinol., 2008, 286(1-2), 192-198.
[16]
Abucham, J.; Bronstein, M.D.; Dias, M.L. Management of endocrine disease: Acromegaly and pregnancy: A contemporary review. Eur. J. Endocrinol., 2017, 177(1), R1-R12.
[17]
Saraiva, J.; Gomes, L.; Paiva, S.; Ruas, L.; Carvalheiro, M. Giant macroprolactinoma and pregnancy. Arq. Bras. Endocrinol. Metabol, 2013, 57(7), 558-561.
[18]
Persechini, M.L.; Gennero, I.; Grunenwald, S.; Vezzosi, D.; Bennet, A.; Caron, P. Decreased IGF-1 concentration during the rst trimester of pregnancy in women with normal somatotroph function. Pituitary, 2015, 18, 461-464.
[19]
Laway, B.A. Pregnancy in acromegaly. Ther. Adv. Endocrinol. Metab., 2015, 6(6), 267-272.
[20]
Katznelson, L.; Laws, E.R., Jr; Melmed, S.; Molitch, M.E.; Murad, M.H.; Utz, A.; Wass, J.A. Endocrine Society. Acromegaly: An Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab., 2014, 99(11), 3933-3951.


Rights & PermissionsPrintExport Cite as


Article Details

VOLUME: 19
ISSUE: 2
Year: 2019
Page: [214 - 220]
Pages: 7
DOI: 10.2174/1871530318666180807160712
Price: $58

Article Metrics

PDF: 21
HTML: 1