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Role of Receptor Profiling for Personalized Therapy in a Patient with a Growth Hormone-Secreting Macroadenoma Resistant to First-Generation Somatostatin Analogues

1
Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko Hospital, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
2
Department of Pathology, Evangelismos Hospital, 115 27 Athens, Greece
3
First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
4
Centre for Endocrinology, William Harvey Institute, Barts and the London School of Medicine, E1 2AT London, UK
5
Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX3 7LE Oxford, UK
*
Author to whom correspondence should be addressed.
J. Pers. Med. 2019, 9(4), 48; https://doi.org/10.3390/jpm9040048
Received: 27 October 2019 / Revised: 10 November 2019 / Accepted: 12 November 2019 / Published: 15 November 2019
Background: Acromegaly is almost always caused by a pituitary adenoma and is associated with high morbidity and mortality when uncontrolled. Trans-sphenoidal removal of the adenoma is the mainstay of therapy, but fails to control the disease in a significant number of patients who require further treatment. Somatostatin analogues (SSAs) as monotherapy or in combination with growth hormone (GH)-receptor antagonists and/or dopamine agonists are used either alone or in combination following surgical failure to achieve disease control. The use of specific biomarkers may help to individualize the therapeutic plan after surgical failure and direct towards a more personalized approach. Methods: We report a 41-year-old man with acromegaly and residual disease after repeated surgery that was resistant to first-generation SSAs. Results: Biochemical and tumor control were achieved following the administration of a second-generation SSA, pasireotide, combined with pegvisomant, both at maximal doses and along with cabergoline. Histology specimens showed a sparsely-granulated GH-immunostaining pituitary adenoma with intense positivity for somatostatin receptors 2 and 5 and low levels of E-cadherin. Conclusion: Personalized medical therapy guided by currently available biomarkers, such as immunohistochemically-characterized receptor profiling or adhesion molecules, resulted in controlled insulin-like growth factor-1 (IGF-1) and GH levels and symptom alleviation following the combination of three drug-classes. View Full-Text
Keywords: acromegaly; personalized treatment; somatostatin receptor; e-cadherin; resistant acromegaly; somatostatin analogue acromegaly; personalized treatment; somatostatin receptor; e-cadherin; resistant acromegaly; somatostatin analogue
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Alexandraki, K.I.; Papadimitriou, E.; Mavroeidi, V.; Kyriakopoulos, G.; Xydakis, A.; Papaioannou, T.G.; Kolomodi, D.; Kaltsas, G.A.; Grossman, A.B. Role of Receptor Profiling for Personalized Therapy in a Patient with a Growth Hormone-Secreting Macroadenoma Resistant to First-Generation Somatostatin Analogues. J. Pers. Med. 2019, 9, 48.

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