Eight-year follow-up of a child with a GH/prolactin-secreting adenoma: efficacy of pegvisomant therapy.
A 3.4-year-old girl was admitted to the Pediatric Department because of tall stature (116.0 cm, +5.1 SDS) and increased height velocity (16.3 cm/year, +6.1 SDS). Basal hormonal evaluation revealed elevated insulin-like growth factor I (IGF-I) levels (938 ng/ml, nv 40-190), prolactin (PRL) (98.0 ng/ml, nv 1.7-24.0) and mean growth hormone (GH) nocturnal concentration (147 ng/ml). Basal adrenal, gonadal and thyroid functions were normal. Hand-wrist bone age was 3.6 years. Magnetic resonance imaging revealed a macroadenoma with moderate suprasellar invasion. The adenoma was surgically removed and histological characterization confirmed the diagnosis of GH/PRL-secreting adenoma. The patient was admitted to our Endocrine Unit when 7.9 years old, because of the persistence of elevated GH, IGF-I and PRL levels, although there was a slight height velocity reduction and absence of tumor recurrence. Treatment with cabergoline was initiated, but only PRL levels normalized. Afterwards, octreotide long-acting release (LAR) was added without reaching the normalization of GH and IGF-I levels. Thus, treatment with octreotide LAR was discontinued and pegvisomant was added to cabergoline, leading to the normalization of IGF-I levels and height velocity without side effects. Other anterior pituitary functions were always normal. To conclude, treatment of pituitary gigantism with pegvisomant was effective and well tolerated in a young giant unresponsive to combined cabergoline and octreotide treatment.
Bergamaschi
S
S
Medical Sciences, University of Milan, Milan, Italy.
Ronchi
C L
CL
Giavoli
C
C
Ferrante
E
E
Verrua
E
E
Ferrari
D I
DI
Lania
A
A
Rusconi
R
R
Spada
A
A
Beck-Peccoz
P
P
D000236:Adenoma / Q000150:complications / Q000188:drug therapy*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005877:Gigantism / Q000188:drug therapy / Q000209:etiology; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy*; D006727:Hormone Antagonists / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D010911:Pituitary Neoplasms / Q000150:complications / Q000188:drug therapy*; D015175:Prolactinoma / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D006727:Hormone Antagonists; D019382:Human Growth Hormone; C406545:pegvisomant