title: Peptide receptor radionuclide therapy in a patient with disabling non-functioning pituitary adenoma.
abstract: Non-functioning pituitary adenoma (NFPA) with higher proliferation index (WHO II) are often a therapeutical challenge. Low somatostatin receptor expression in these tumors usually prevents a treatment with somatostatin analogs. In 1996, a 55-year-old patient was referred due to right-sided headache. A pituitary macroadenoma with infiltration into the right cavernous sinus was diagnosed. There was no visual field deficit and the clinical and biochemical work up was consistent with a NFPA. The patient underwent transsphenoidal surgery. Residual adenoma remained in the right cavernous sinus. Histologically, a null-cell adenoma with a high proliferation index was documented (MIB-1: 11.6%, WHO II). Somatostatin receptor autoradiography was performed in the surgical specimen showing a homogenous expression of sst2 receptors. Radiosurgery was completed with stable disease for 8 years. In 2004, the patient was diagnosed with an incomplete palsy of the right oculomotorius nerve and a significant increase in the volume of the adenoma in the right cavernous sinus. After a positive Octreoscan(®) the patient consented to an experimental therapy approach using Lutetium DOTATOC (3 × 200 mCi). The palsy of the oculomotorius nerve improved and remained stable until today (March 2013), the follow-up MRI scans demonstrated stable disease. This is the first case of a patient with a NFPA (WHO II) in whom PRRT successfully improved the local complications of the tumor for more than 8 years after ineffective surgery and gamma knife therapy. The determination of sst2 in vitro using autoradiography and in vivo by Octreoscan was instrumental to administer this therapy in a challenging situation.
authors.affiliation: , Bühlstrasse 5, 3012, Bern, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Komor
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Reubi
authors.forename: Emanuel R
authors.initials: ER
authors.lastname: Christ
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D015282:Octreotide / Q000031:analogs & derivatives / Q000627:therapeutic use; D009886:Ophthalmoplegia / Q000209:etiology / Q000532:radiotherapy; D010911:Pituitary Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D018000:Receptors, Peptide / Q000187:drug effects*; D017481:Receptors, Somatostatin / Q000187:drug effects / Q000528:radiation effects; D013004:Somatostatin / Q000031:analogs & derivatives
chemical_list: D019275:Radiopharmaceuticals; D018000:Receptors, Peptide; D017481:Receptors, Somatostatin; D013004:Somatostatin; C081788:pentetreotide; D015282:Octreotide; C106246:Edotreotide