Pasireotide as first line medical therapy for selected patients with acromegaly

In acromegaly, growth hormone (GH) excess and pituitary tumours are typically managed through transsphenoidal surgery, often in combination with somatostatin receptor ligands (SRLs) given either before or following surgery. Although first-generation SRLs (lanreotide and octreotide) are efficacious in many patients, some exhibit resistance.

We present the efficacy of the second-generation SRL, pasireotide, in six patients anticipated to be resistant to first-generation SRLs. The patients had large, hyperintense tumors on T2-weighted MRI and sparse granulation pattern by histology.

Over three to eight months, pasireotide reduced tumour volume in all patients and improved GH and IGF-1 levels. Visual field defects normalised. Despite hyperglycemia, requiring antidiabetic treatment in two patients, pasireotide proved effective as a first pharmacological therapy.

This series supports the use of pasireotide for rapid tumour control and GH reduction, in selected patients with complex and large tumours, likely to be resistant to first-generation SRLs. This approach expands the therapeutic options for managing the most challenging cases enhancing the potential for other subsequent treatment modalities.