title: The role of an acute pasireotide suppression test in predicting response to treatment in patients with Cushing's disease: findings from a pilot study.
abstract: Pasireotide is a multireceptor-targeted somatostatin analog effective in the treatment of Cushing's disease (CD). We evaluate the value of an acute pasireotide suppression test (PST) in predicting response to medium/long-term treatment in CD. Nineteen patients with active CD were prospectively investigated at two referral centers from May 2013 to August 2014. Follow-up data (median 6 months; range 1-9 months) were available for sixteen patients. All patients received at 09:00 h a single subcutaneous (sc) injection of 600 μg pasireotide. Serum cortisol and plasma ACTH were assessed before, and every 2 h for 8 h after, drug administration. Late-night salivary cortisol (LNSC) was assessed before and after pasireotide administration. After acute PST, all patients were continued on pasireotide 600 μg sc twice a day. During PST, cortisol and ACTH levels quickly decreased in all patients except one with a mean percentage fall, respectively, of 48.9 ± 24.3 and 48.1 ± 25.4 % compared to baseline. LNSC decreased in about 82 % of patients (14/17) achieving a normalization in five of them. Pasireotide treatment was associated with a normalization of 24-h urinary-free cortisol at last follow-up in about 68 % of patients. A fall >27 % of LNSC during PST calculated by ROC curve was the best parameter in predicting a positive response to treatment with pasireotide (sensitivity 91 %; specificity 100 %; positive predictive value 100 %; negative predictive value 75 %). Acute PST may be useful to identify CD patients who will benefit from pasireotide treatment. A LNSC fall >27 % as well as a LNSC normalization during PST is associated with a probability of 100 % of achieving a favorable response to pasireotide treatment in the medium/long term.
authors.affiliation: Division of Endocrinology, University Hospital of Ancona, Polytechnic University of Marche, Via Conca 71, 60020, Torrette di Ancona, AN, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Trementino
authors.forename: M
authors.initials: M
authors.lastname: Zilio
authors.forename: G
authors.initials: G
authors.lastname: Marcelli
authors.forename: G
authors.initials: G
authors.lastname: Michetti
authors.forename: M
authors.initials: M
authors.lastname: Barbot
authors.forename: F
authors.initials: F
authors.lastname: Ceccato
authors.forename: M
authors.initials: M
authors.lastname: Boscaro
authors.forename: C
authors.initials: C
authors.lastname: Scaroni
authors.forename: G
authors.initials: G
authors.lastname: Arnaldi
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood* / Q000187:drug effects; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D047748:Pituitary ACTH Hypersecretion / Q000097:blood* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D012463:Saliva / Q000737:chemistry / Q000187:drug effects; D012680:Sensitivity and Specificity; D013004:Somatostatin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D055815:Young Adult
chemical_list: D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; C517782:pasireotide; D006854:Hydrocortisone