Long-term effects of octreotide on pituitary gigantism: its analgesic action on cluster headache.
We report the case of 19-year-old man with pituitary gigantism due to growth hormone-producing pituitary macroadenoma. The patient complained of recurrent headache and excessive growth spurt since age 15. Octreotide administration was initiated following transsphenoidal pituitary adenomectomy. Octreotide injection for 4 years efficaciously reduced the size of remnant adenoma as well as serum growth hormone levels. Notably, octreotide exhibited a potent analgesic effect on his intractable cluster headache that has continued even after reduction of the adenoma volume. The analgesic effect lasted 2 to 6 hours after each injection and no tachyphylaxis to octreotide appeared during 4-year treatment. To characterize the headache and the pain intensity, analgesic drugs including octreotide, lidocaine, morphine and thiopental were tested using a visual analogue scale (VAS) evaluation, with the result that octreotide exhibited a prompt and complete disappearance of the headache. Headache relief was in part reproduced by morphine injection (56% reduction) but not by lidocaine or thiopental. The present case suggests that the intractable headache associated with pituitary gigantism is possibly related to the endogenous opioid system. Thus, the headache control by octreotide is clinically helpful for continuation of the self-injection regimen.
Otsuka
Fumio
F
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry, Japan.
Mizobuchi
Satoshi
S
Ogura
Toshio
T
Sato
Kenji
K
Yokoyama
Masataka
M
Makino
Hirofumi
H
D000236:Adenoma / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D003027:Cluster Headache / Q000188:drug therapy* / Q000209:etiology; D005877:Gigantism / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D015282:Octreotide / Q000008:administration & dosage*; D010147:Pain Measurement; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy*; D012646:Self Administration
D000701:Analgesics, Opioid; D018931:Antineoplastic Agents, Hormonal; D009020:Morphine; D015282:Octreotide