open access

Ahead of print
Clinical vignette
Published online: 2021-03-22
Submitted: 2021-02-06
Accepted: 2021-02-23
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Giant silent corticotrope pituitary adenoma in a patient with complicated clinical course

Ognian Kalev, Marina Hodolic, Berndt Tomancok, Michael Sonnberger, Markus Hutterer, Daniela Ehrlich, Robert Pichler
DOI: 10.5603/EP.a2021.0027
·
Pubmed: 33749817

open access

Ahead of print
Clinical Vignette
Published online: 2021-03-22
Submitted: 2021-02-06
Accepted: 2021-02-23

Abstract

Introduction Somatostatin analogues are a cornerstone in the treatment of acromegaly. Somatostatin analogues of the first generation, mainly targeting the somatostatin receptor (SSTR) subtype 2, proofed to be efficient in most patients with acromegaly. With the development of somatostatin analogues targeting the subtype 5 additionally to the subtype 2, i.e. pasireotide, an efficient drug for ACTH secreting pituitary tumors and suboptimal responding acromegaly patients became available. Methods We investigated immunohistochemically SSTR subtypes expression in three pituitary adenomas: two from operated acromegaly patients with clinical relapse and one from a patient with clinically silent ACTH-positive macroadenoma with unfavourable clinical course. Results The predictive value of SSTR subtypes immunhistochemical analysis for the therapeutic response was discussed. The one silent corticotroph adenoma case presented here was negative for subtype 2 as well as for subtype 5 and therefore we did not see an indication for somatostatin analogue therapy. In acromegaly high Ki-67 appeared to have a negative impact upon therapeutic response in the two cases. Conclusion The immunohistochemical analysis of SSTR subtypes expression in pituitary adenoma patients especially with acromegaly and complicated clinical course might be helpful for decision making or prognostic significance. Our case reports point to the need of clinical trials for further investigation.

Abstract

Introduction Somatostatin analogues are a cornerstone in the treatment of acromegaly. Somatostatin analogues of the first generation, mainly targeting the somatostatin receptor (SSTR) subtype 2, proofed to be efficient in most patients with acromegaly. With the development of somatostatin analogues targeting the subtype 5 additionally to the subtype 2, i.e. pasireotide, an efficient drug for ACTH secreting pituitary tumors and suboptimal responding acromegaly patients became available. Methods We investigated immunohistochemically SSTR subtypes expression in three pituitary adenomas: two from operated acromegaly patients with clinical relapse and one from a patient with clinically silent ACTH-positive macroadenoma with unfavourable clinical course. Results The predictive value of SSTR subtypes immunhistochemical analysis for the therapeutic response was discussed. The one silent corticotroph adenoma case presented here was negative for subtype 2 as well as for subtype 5 and therefore we did not see an indication for somatostatin analogue therapy. In acromegaly high Ki-67 appeared to have a negative impact upon therapeutic response in the two cases. Conclusion The immunohistochemical analysis of SSTR subtypes expression in pituitary adenoma patients especially with acromegaly and complicated clinical course might be helpful for decision making or prognostic significance. Our case reports point to the need of clinical trials for further investigation.

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Keywords

acromegaly; Cushing´s disease; somatostatin receptor subtype; immunohistochemistry; somatostatin analogues

About this article
Title

Giant silent corticotrope pituitary adenoma in a patient with complicated clinical course

Journal

Endokrynologia Polska

Issue

Ahead of print

Article type

Clinical vignette

Published online

2021-03-22

DOI

10.5603/EP.a2021.0027

Pubmed

33749817

Keywords

acromegaly
Cushing´s disease
somatostatin receptor subtype
immunohistochemistry
somatostatin analogues

Authors

Ognian Kalev
Marina Hodolic
Berndt Tomancok
Michael Sonnberger
Markus Hutterer
Daniela Ehrlich
Robert Pichler

References (6)
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  2. de Bruin C, Feelders RA, Lamberts SWJ, et al. Somatostatin and dopamine receptors as targets for medical treatment of Cushing's Syndrome. Rev Endocr Metab Disord. 2009; 10(2): 91–102.
  3. de Herder WW, Reijs AEM, Feelders RA, et al. Diagnostic imaging of dopamine receptors in pituitary adenomas. Eur J Endocrinol. 2007; 156 Suppl 1: S53–S56.
  4. Liu H, Zakiniaeiz Y, Cosgrove KP, et al. Toward whole-brain dopamine movies: a critical review of PET imaging of dopamine transmission in the striatum and cortex. Brain Imaging Behav. 2019; 13(2): 314–322.
  5. de Bruin C, Pereira AM, Feelders RA, et al. Coexpression of dopamine and somatostatin receptor subtypes in corticotroph adenomas. J Clin Endocrinol Metab. 2009; 94(4): 1118–1124.
  6. Gabalec F, Beranek M, Netuka D, et al. Dopamine 2 receptor expression in various pathological types of clinically non-functioning pituitary adenomas. Pituitary. 2012; 15(2): 222–226.

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