Pasireotide for a Patient with Acromegaly and Chronic Kidney Disease on Hemodialysis

ABSTRACT Objective: Acromegaly is a rare disease. Medical management with somatostatin analogs and the growth hormone receptor antagonist pegvisomant can normalize insulin-like growth factor-1 (IGF1) levels after failed surgery and decrease mortality and comorbidities. We present a case report of a patient with acromegaly on chronic hemodialysis resistant to first-generation, long-acting somatostatin analogs with remarkable response to pasireotide long-acting release (PAS-LAR). Methods:A 66-year-old woman with acromegaly and chronic renal failure on hemodialysis resistant to lanreo-tide autogel (at 120 mg) was treated successfully with PAS-LAR. Results: Acromegaly was diagnosed in 1996 and transsphenoidal resection of macroadenoma was performed with normalization of IGF1 levels. Nine years later, recurrence of the tumor led to a second operation. Lanreotide autogel was initiated due to persistently high levels of IGF1, but the patient was resistant to treatment. A positive response was observed with pegvisomant. However, the patient was nonadherent and treatment was discontinued. PAS-LAR was initiated and normalization of IGF1 and growth hormone was achieved. Conclusion: This is the first case report of a patient with acromegaly on chronic hemodialysis who was resistant to first-generation, long-acting somatostatin analogs and successfully treated with PAS-LAR. Abbreviations: GH = growth hormone; IGF1 = insulin-like growth factor-1; LA-SSA = long-acting somatostatin analog; MRI = magnetic resonance imaging; PAS-LAR = pasireotide long-acting release; PEGV = pegvisomant; SSTR = somatostatin receptor