title: A decrease in the dose of pegvisomant was needed for the treatment of acromegaly after adrenalectomy in a patient with coexisting preclinical Cushing's syndrome.
abstract: We herein describe the case of a 47-year-old woman with pre-clinical Cushing's syndrome caused by a left adrenal adenoma, which was diagnosed 6 years after trans-sphenoidal selective removal of a pituitary adenoma for acromegaly at age 35. The patient was started on bromocriptine and then somatostatin analogues after the surgery; however, since her serum insulin-like growth factor-1 (IGF-1) values remained above the age-adjusted normal range, the treatment for acromegaly was switched from somatostatin analogues to pegvisomant (10 mg daily), before a left laparoscopic adrenalectomy. After the subsequent adrenalectomy, the dose of pegvisomant could be reduced gradually to once every 4 days without any increase in the serum IGF-1 values. This is the first report describing the need for a different dose of pegvisomant for the treatment of acromegaly before and after adrenalectomy for pre-clinical Cushing's syndrome.
authors.affiliation: Department of Metabolism and Endocrinology, National Hospital Organization, Kyushu Medical Center, Japan. aogo@kyumed.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogo
authors.forename: Yuka
authors.initials: Y
authors.lastname: Matoba
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hiramatsu
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D000315:Adrenalectomy; D015897:Comorbidity; D003480:Cushing Syndrome / Q000453:epidemiology / Q000378:metabolism / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D019382:Human Growth Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008875:Middle Aged
chemical_list: D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; C406545:pegvisomant