scholarly journals Effects of combination therapy: somatostatin analogues and dopamine agonists on GH and IGF1 levels in acromegaly

2015 ◽  
Vol 88 (3) ◽  
pp. 310-313 ◽  
Author(s):  
Ana Valea ◽  
Cristina Ghervan ◽  
Mara Carsote ◽  
Andra Morar ◽  
Iulia Iacob ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Combination Therapy ◽  
Dopamine Agonist ◽  
Normal Level ◽  
Dopamine Agonists ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Endocrine Disorder ◽  
Excessive Secretion

 Background and aims. Acromegaly is a complex endocrine disorder caused by excessive secretion of GH, secondary to a GH secreting pituitary adenoma or a mixed pituitary adenoma secreting GH and PRL.Methods. The aim of this study was to evaluate the effects of combination therapy: dopamine agonist and somatostatin analogue on GH and IGF1 levels in a group of 30 patients with acromegaly. Cabergoline in a dose of 2 mg/week and 4 mg/week respectively was associated with Sandostatin LAR in a dose of 20 mg/month and 30 mg/months respectively. Eight patients were treated with Lanreotide 30 mg/week and Cabergoline 2 mg/week and 3 patients were treated with Bromocriptine 10 mg/day and Sandostatin LAR 30 mg/month.Results. Combination therapy: Cabergoline and Sandostatin achieved normal levels of IGF1  in 32% of the patients, better results being obtained after 12 months of treatment in the group treated with 4 mg Cabergoline/week. In 37% of cases the levels of IGF1 decreased by 50% after 12 months of treatment. In the group treated with Cabergoline and Somatuline a normal level of IGF1 was achieved in 25% of patients after 12 months of treatment. The outcome for the group treated with Sandostatin and Bromocriptine was similar to that obtained under Cabergoline 2 mg/week. There was no significant correlation between the level of GH and the type or dose of dopamine agonist used.Conclusions. In conclusion, combination therapy consisting of dopamine agonist and somatostatin analogue achieves a significant reduction of IGF1 levels in patients with mixed adenomas secreting GH and PRL. A decrease in IGF1 levels is directly correlated with the dose of Cabergoline used. 

Somatostatin analogues, dopamine agonists or growth hormone antagonists for pituitary adenoma-induced acromegaly.

2010 ◽  
Author(s):  
Eric V Balti ◽  
Elvis A Akwo ◽  
Leopold Fezeu ◽  
Andre Pascal Kengne ◽  
Eugene Sobngwi ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Dopamine Agonists ◽  
Somatostatin Analogues ◽  
Hormone Antagonists

scholarly journals A Rare Case of Thyrotropin Secreting Pituitary Macroadenoma Primarily Treated With Somatostatin Analogue

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A568-A568
Author(s):  
Arwa Mahmoud Elsheikh ◽  
G Edward Vates ◽  
Ismat Shafiq
Keyword(s):  
Pituitary Adenoma ◽  
Medical Treatment ◽  
Thyroid Function ◽  
Pituitary Adenomas ◽  
Rare Case ◽  
Somatostatin Analogues ◽  
Primary Treatment ◽  
Alpha Subunit ◽  
Somatostatin Analogue ◽  
Pituitary Macroadenoma

Abstract Introduction/Background: Thyrotropin secreting pituitary adenomas (TSH-oma) are a rare cause of hyperthyroidism. They account for <1% of the cases of hyperthyroidism with a reported incidence of 2.8 per 1 million in Sweden. Diagnosis is suspected by the presence of elevated T4 and T3 in the setting of an unsuppressed TSH level. The presence of large pituitary adenoma is highly suggestive of the diagnosis and can be differentiated from thyroid hormone resistance by elevated alpha subunit and SHBG levels. Trans-sphenoidal surgery is the definitive treatment. Peri-operative medical treatment with somatostatin analogues is indicated to achieve euthyroidism and prevent surgical risks and thyroid storm. The use of somatostatin analogues as a primary treatment for TSH-oma is still under investigation. We hereby report a rare case of TSH-oma where somatostatin analogues successfully resulted in normalization of thyroid function and tumor size reduction. Clinical Case: A 61 years old gentleman with a history of hypothyroidism diagnosed three years before presentation to the Pituitary clinic. He was treated with Levothyroxine. On clinical examination, he had mild tremor and warm sweaty palms with no stigmata of Grave’s disease. The thyroid function test showed elevated free T4 of 3.6 ng/dl (0.9-1.7), elevated free T3 of 8.6 pg/ml (2.0-4.4), and a high TSH level of 9.10 μIU/ml (0.27-4.20). His prolactin level was mildly elevated at 24.8 ng/ml(4.0-15.2). Testosterone, IGF-1, and cortisol levels were normal. An MRI of his pituitary gland showed large pituitary macroadenoma with supra-sellar extension and mild compression of the optic nerve. He had an elevated alpha subunit of 5.6 ng/ml (<1.37) and a high SHBG level of 198 nmol/l(10-80). TSH adenoma was diagnosed and he was planned for trans-sphenoidal surgery. Pre-operative treatment with somatostatin analogue Lanerotide 90 mg monthly injection was initiated. Interestingly normal thyroid function was observed approximately 1 month after his first injection. Repeat MRI showed a considerable decrease in the size of the pituitary macroadenoma. The patient opted to hold on to surgery and to continue on medical treatment. His thyroid function remains normal 15 months after initiation of treatment and his MRI continues to show stable pituitary adenoma. Conclusion: Somatostatin analogues can be used as a primary treatment for thyrotropin secreting pituitary adenomas when the patient is unable or unwilling to undergo surgery. It is use is associated with normalization of thyroid function and in some cases with a reduction in the adenoma size.

High dose dopamine agonist treatment and combination of dopamine agonists

2005 ◽  
Vol 32 (06) ◽  
Author(s):  
P Odin ◽  
C Oehlwein ◽  
A Storch ◽  
U Polzer ◽  
G Werner ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
High Dose

Apoplexy of microprolactinomas during pregnancy

2021 ◽  
Author(s):  
Emmanuelle Kuhn ◽  
Alexandra A Weinreich ◽  
N R Biermasz ◽  
Jens Otto L. Jorgensen ◽  
Philippe Chanson
Keyword(s):  
Literature Review ◽  
Dopamine Agonist ◽  
Systematic Literature Review ◽  
Dopamine Agonists ◽  
Pituitary Apoplexy ◽  
Clinical Event ◽  
Female Patients ◽  
Pregnancy Diagnosis ◽  
Assessment And Treatment ◽  
Ophthalmological Assessment

Abstract Context: Prolactinomas frequently cause amenorrhoea, galactorrhoea and infertility and require dopamine agonist (DA) treatment to normalize prolactin levels and hence restore ovulation. The vast majority of female patients harbour microprolactinomas in whom DA treatment is usually discontinued at the time of pregnancy diagnosis, and surveillance is generally limited as symptomatic growth is considered very rare. Case Descriptions: We report five cases of women harbouring a microprolactinoma in whom symptomatic pituitary apoplexy occurred during pregnancy. Only one necessitated surgery during pregnancy, while the others were treated conservatively by reintroducing DAs in three. A systematic literature review found reports of four additional cases among 20 cases of prolactinomas (both macro- and microprolactinomas) complicated by apoplexy during pregnancy. Conclusion: During pregnancy, pituitary apoplexy may occur in pre-existing microprolactinomas, causing tumour enlargement and headache, which may be self-limiting but may require intervention by re-initation of dopamine agonists or surgery. Our literature review confirms that this clinical event is rare; nevertheless, physicians managing pregnant patients with microprolactinomas must be aware that symptomatic pituitary apoplexy may incidentally occur in all trimesters of pregnancy and require prompt radiological, endocrine and ophthalmological assessment and treatment.

scholarly journals Dopamine agonist and tamoxifen combination therapy for a prolactin-secreting pituitary tumor resistant to dopamine agonist monotherapy: Case report and review

2020 ◽  
Vol 21 ◽  
pp. 100777
Author(s):  
Zachary K. Christian ◽  
Kimmo J. Hatanpaa ◽  
Richard J. Auchus ◽  
Stephen R. Hammes ◽  
Ankur R. Patel ◽  
...  
Keyword(s):  
Case Report ◽  
Combination Therapy ◽  
Dopamine Agonist ◽  
Pituitary Tumor

scholarly journals Challenges in the functional diagnosis of thyroid nodules before surgery for TSH-producing pituitary adenoma

2021 ◽  
Vol 2021 ◽  
Author(s):  
Keita Tatsushima ◽  
Akira Takeshita ◽  
Shuji Fukata ◽  
Noriaki Fukuhara ◽  
Mitsuo Yamaguchi-Okada ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Thyroid Hormone ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Thyroid Stimulating Hormone ◽  
Somatostatin Analogue ◽  
Postoperative Phase ◽  
List Type ◽  
Thyroid Scintigraphy ◽  
Serum Tsh

Summary A 50-year-old woman with thyroid-stimulating hormone (TSH)-producing pituitary adenoma (TSHoma) was diagnosed due to symptoms of thyrotoxicosis. Preoperatively, she showed thyrotoxicosis with the syndrome of inappropriate secretion of TSH (SITSH) and had a 5 cm nodule in her thyroid gland. Octreotide was administered preoperatively, which helped lower her serum TSH level but not her thyroid hormone level. These findings were atypical for a patient with TSHoma. The TSHoma was completely resected, and the TSH level dropped below the sensitivity limit shortly after surgery. Interestingly, however, thyroid hormone levels remained high. A clear clue to the aetiology was provided by consecutive thyroid scintigraphy. Although preoperative thyroid scintigraphy did not show a hot nodule and the mass was thought to be a non-functional thyroid nodule, the nodule was found to be hot in the postoperative phase of TSH suppression. By focusing on the atypical postoperative course of the TSHoma, we were able to conclude that this was a case of TSHoma combined with an autonomously functioning thyroid nodule (AFTN). Learning points The diagnosis of autonomously functioning thyroid nodules (AFTNs) depends on suppressed serum TSH levels. If thyroid hormones are resistant to somatostatin analogue therapy or surgery for TSHoma, complications of AFTN as well as destructive thyroiditis need to be considered. It is important to revisit the basics when facing diagnostic difficulties and not to give up on understanding the pathology.

scholarly journals Somatostatin and gastrointestinal tract. Clinical experiences

2013 ◽  
Vol 154 (39) ◽  
pp. 1535-1540 ◽  
Author(s):  
László Herszényi ◽  
Emese Mihály ◽  
Zsolt Tulassay
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Hormones ◽  
Gastrointestinal Diseases ◽  
Somatostatin Analogues ◽  
Therapeutic Modality ◽  
Exocrine Function ◽  
Somatostatin Analogue ◽  
Clinical Experiences ◽  
Pancreatic Fistulas ◽  
Long Acting

The effect of somatostatin on the gastrointestinal tract is complex; it inhibits the release of gastrointestinal hormones, the exocrine function of the stomach, pancreas and bile, decreases motility and influences absorption as well. Based on these diverse effects there was an increased expectation towards the success of somatostatin therapy in various gastrointestinal disorders. The preconditions for somatostatin treatment was created by the development of long acting somatostatin analogues (octreotide, lanreotide). During the last twenty-five years large trials clarified the role of somatostatin analogues in the treatment of various gastrointestinal diseases. This study summarizes shortly these results. Somatostatin analogue treatment could be effective in various pathological conditions of the gastrointestinal tract, however, this therapeutic modality became a part of the clinical routine only in neuroendocrine tumours and adjuvant treatment of oesophageal variceal bleeding and pancreatic fistulas. Orv. Hetil., 2013, 154, 1535–1540.

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