title: Growth hormone-secreting macroadenoma of the pituitary gland successfully treated with the radiolabeled somatostatin analog (90)Y-DOTATATE: case report.
abstract: Pituitary tumors causing acromegaly are usually macroadenomas at the time of diagnosis, and they can grow aggressively, infiltrating surrounding tissues. Difficulty in achieving complete tumor removal at surgery can lead toward a strong tendency for recurrence, making it necessary to consider a means of treatment other than those currently used such as somatostatin analogs (SSAs), growth hormone (GH) receptor antagonist, surgical removal, and radiotherapy. The purpose of this paper is to describe a patient diagnosed with an aggressive, giant GH-secreting tumor refractory to medical therapy but ultimately treated with the radiolabeled somatostatin analog (90)Y-DOTATATE. A 26-year-old male with an invasive macroadenoma of the pituitary gland (5.6 × 2.5 × 3.6 cm) and biochemically confirmed acromegaly underwent 2 partial tumor resections: the first used the transsphenoidal approach and the second used the transcranial method. The patient received SSAs pre- and postoperatively. Because of the progression in pituitary tumor size, he underwent classic irradiation of the tumor (50 Gy). One and a half years later, the patient presented with clinically and biochemically active disease, and the tumor size was still 52 mm in diameter (height). Two neurosurgeons disqualified him from further surgical procedures. After confirming the presence of somatostatin receptors in the pituitary tumor by using (68)Ga-DOTATATE PET/CT, we treated the patient 4 times with an SSA bound with (90)Y-DOTATATE. After this treatment, the patient attained partial biochemical remission and a reduction in the tumor mass for the first time. Treatment with an SSA bound with (90)Y-DOTATATE may be a promising option for some aggressive GH-secreting pituitary adenomas when other methods have failed.
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Joanna
authors.initials: J
authors.lastname: Waligórska-Stachura
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Paweł
authors.initials: P
authors.lastname: Gut
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Nadia
authors.initials: N
authors.lastname: Sawicka-Gutaj
authors.affiliation: Neurosurgery and Neurotraumatology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Liebert
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Maria
authors.initials: M
authors.lastname: Gryczyńska
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Daria
authors.initials: D
authors.lastname: Baszko-Błaszyk
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Al Ricardo
authors.initials: AR
authors.lastname: Blanco-Gangoo
authors.affiliation: Departments of 1 Endocrinology, Metabolism and Internal Medicine and.
authors.forename: Marek
authors.initials: M
authors.lastname: Ruchała
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000627:therapeutic use*; D012074:Remission Induction; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: C539274:90Y-octreotate, DOTA(0)-Tyr(3)-Thr(8)-; D009942:Organometallic Compounds; D013004:Somatostatin; D015282:Octreotide
keywords: 90Y-DOTATATE; ACTH = adrenocorticotropic hormone; GH; GH = growth hormone; SSA = somatostatin analog; SSTR = somatostatin receptor; growth hormone; pituitary surgery; pituitary tumor