{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:47:56Z","timestamp":1777312076187,"version":"3.51.4"},"reference-count":62,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024]]},"abstract":"<jats:p>Background: The somatostatin analog, pasireotide, is used for the treatment of acromegaly after the failure of surgery and\/or first-line medical treatment.<\/jats:p>\n                  <jats:p>\n                    Case Presentation: A 48-year-old male reported that during a workup for obesity in his home country, hyperprolactinemia was diagnosed and a 3.5 \u00d7 3.5 cm pituitary macroadenoma was identified on pituitary MRI. He received cabergoline for 6 months; then he was lost to follow-up. He presented at our Endocrine clinic 2 years later for treatment of obesity (BMI 49.5 kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ). Biochemical workup revealed that in addition to hyperprolactinemia (7,237 [normal: 85\u2013323 mIU\/L), he had acromegaly, evident by elevated insulin-like growth factor 1 (IGF-1) level (450 [normal: 88\u2013210 \u00b5g\/L]), and a positive growth hormone suppression test, secondary hypothyroidism, and secondary hypogonadism. Pituitary MRI showed that the adenoma encased parts of the left and right internal carotid arteries and encroached on the optic chiasm. Surgical excision was therefore not feasible. He was treated with cabergoline and later, long-acting release (LAR) octreotide. Prolactin levels were reduced with cabergoline, but IGF-1 levels did not respond to octreotide, and it was discontinued. The patient abandoned radiotherapy after two sessions. He was started on LAR pasireotide 40 mg every 4 weeks and continued on cabergoline 0.5 mg per week. His biochemical response was dramatic, with a near normalization of IGF-1 levels in 3 months. After 6 months from starting pasireotide, we increased cabergoline dose from 0.5 mg\/week to 3 mg\/week. Three months later, IGF-1 level was normalized. The patient developed type 2 diabetes as a side effect of pasireotide; however, this was well-controlled with medications.\n                  <\/jats:p>\n                  <jats:p>Conclusions: The case suggests that pasireotide can provide marked biochemical improvement in acromegaly after the failure of both cabergoline monotherapy and cabergoline plus octreotide. This further confirms a potentially efficacious treatment regimen in treatment-resistant acromegaly with hyperprolactinemia.<\/jats:p>","DOI":"10.5339\/qmj.2024.17","type":"journal-article","created":{"date-parts":[[2024,3,17]],"date-time":"2024-03-17T03:30:37Z","timestamp":1710646237000},"source":"Crossref","is-referenced-by-count":2,"title":["Successful medical management of a pituitary macroadenoma with features of resistant acromegaly and hyperprolactinemia using pasireotide"],"prefix":"10.5339","volume":"2024","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-2694","authenticated-orcid":true,"given":"Khaled Ahmed","family":"Baagar","sequence":"first","affiliation":[{"name":"Diabetes and Endocrine Department, Hamad Medical Corporation, Doha, Qatar Email: kbaagar@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6965-5916","authenticated-orcid":true,"given":"Amna","family":"Sadiq","sequence":"additional","affiliation":[{"name":"Radiology Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-1539","authenticated-orcid":true,"given":"Adeel Ahmad","family":"Khan","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Department, Hamad Medical Corporation, Doha, Qatar Email: kbaagar@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7022-3806","authenticated-orcid":true,"given":"Zeinab","family":"Dabbous","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Department, Hamad Medical Corporation, Doha, Qatar Email: kbaagar@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-1506","authenticated-orcid":true,"given":"Zaina","family":"Rohani","sequence":"additional","affiliation":[{"name":"Diabetes and Endocrine Department, Hamad Medical Corporation, Doha, Qatar Email: kbaagar@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"BMC Endocr Disord","first-page":"10","article-title":"Prolactinomas, Cushing\u2019s disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas","volume":"10","author":"Biller\n \nBM","year":"2010;"},{"issue":"(5):","key":"CIT0002","series-title":"Endocr Rev","first-page":"485\u2212534","article-title":"Advances in the treatment of prolactinomas","volume":"27","author":"Gillam\n \nMP","year":"2006;"},{"issue":"(2):","key":"CIT0003","series-title":"J Clin Endocrinol Metab","first-page":"273\u221288","article-title":"Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline","volume":"96","author":"Melmed\n \nS","year":"2011;"},{"issue":"(5):","key":"CIT0004","series-title":"JAMA","first-page":"516\u221224","article-title":"Diagnosis and treatment of pituitary adenomas: a review","volume":"317","author":"Molitch\n \nME","year":"2017;"},{"issue":"(5):","key":"CIT0005","series-title":"Int J Mol Sci","first-page":"1682","article-title":"Somatostatin analogs in clinical practice: a review","volume":"21","author":"Gomes-Porras\n \nM","year":"2020;"},{"issue":"(1):","key":"CIT0006","series-title":"Exp Ther Med","first-page":"74","article-title":"Aggressive prolactinoma (Review)","volume":"23","author":"Valea\n \nA","year":"2022;"},{"issue":"(2):","key":"CIT0007","series-title":"Ann Endocrinol (Paris)","first-page":"84\u20138","article-title":"Pasireotide: a potential therapeutic alternative for resistant 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\nS","year":"2017;"},{"issue":"(1):","key":"CIT0015","series-title":"Pituitary","first-page":"70\u20137","article-title":"Aggressive prolactinomas: how to manage?","volume":"23","author":"Lasolle\n \nH","year":"2020;"},{"issue":"(2):","key":"CIT0016","series-title":"Eur J Endocrinol","first-page":"K21\u20137","article-title":"Excellent response to pasireotide therapy in an aggressive and dopamine-resistant prolactinoma","volume":"181","author":"Coopmans\n \nEC","year":"2019;"},{"issue":"(6):","key":"CIT0017","series-title":"Sleep","first-page":"540\u20135","article-title":"A new method for measuring daytime sleepiness: the Epworth sleepiness scale","volume":"14","author":"Johns\n \nMW","year":"1991;"},{"issue":"(11):","key":"CIT0018","series-title":"J Clin Endocrinol Metab","first-page":"3933\u201351","article-title":"Acromegaly: an endocrine society clinical practice guideline","volume":"99","author":"Katznelson\n \nL","year":"2014;"},{"issue":"(3):","key":"CIT0019","series-title":"Endocrine","first-page":"505\u201310","article-title":"De-escalation treatment with pasireotide for acromegaly: a long-term experience","volume":"80","author":"Giampietro\n \nA","year":"2023;"},{"issue":"(3):","key":"CIT0020","series-title":"J Clin Endocrinol Metab","first-page":"791\u20139","article-title":"Pasireotide versus octreotide in acromegaly: a head-to-head superiority study","volume":"99","author":"Colao\n \nA","year":"2014;"},{"issue":"(2):","key":"CIT0021","series-title":"J Clin Endocrinol Metab","first-page":"297\u2013308","article-title":"The future of somatostatin receptor ligands in acromegaly","volume":"107","author":"Gadelha\n \nMR","year":"2022;"},{"issue":"(12):","key":"CIT0022","series-title":"Endocr Connect","first-page":"1178\u201390","article-title":"Risk factors and management of pasireotide-associated hyperglycemia in acromegaly","volume":"9","author":"Gadelha\n 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acromegaly","volume":"99","author":"Ruiz\n \nS","year":"2023"},{"key":"CIT0030","series-title":"Front Endocrinol (Lausanne)","first-page":"648411","article-title":"Pasireotide in the personalized treatment of acromegaly","volume":"12","author":"Puig-Domingo\n \nM","year":"2021;"},{"issue":"(3):","key":"CIT0031","series-title":"Endocr Pract","first-page":"321-32","article-title":"Personalized medical treatment of patients with acromegaly: a review","volume":"28","author":"Lim\n \nDST","year":"2022;"},{"key":"CIT0001","series-title":"BMC Endocr Disord","first-page":"10","article-title":"Prolactinomas, Cushing\u2019s disease and acromegaly: debating the role of medical therapy for secretory pituitary adenomas","volume":"10","author":"Biller\n \nBM","year":"2010;"},{"issue":"(5):","key":"CIT0002","series-title":"Endocr Rev","first-page":"485\u2212534","article-title":"Advances in the treatment of prolactinomas","volume":"27","author":"Gillam\n 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(Tokyo)","first-page":"958\u201365","article-title":"Medical management of functioning pituitary adenoma: an update","volume":"54","author":"Oki\n \nY","year":"2014;"},{"issue":"(1):","key":"CIT0012","series-title":"Endocrine","first-page":"196\u20139","article-title":"Acromegaly can be cured by first-line pasireotide treatment?","volume":"64","author":"Chiloiro\n \nS","year":"2019;"},{"issue":"(11):","key":"CIT0013","series-title":"Lancet Diabetes Endocrinol","first-page":"875\u201384","article-title":"Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial","volume":"2","author":"Gadelha\n \nMR","year":"2014;"},{"issue":"(7):","key":"CIT0014","series-title":"Endocr J","first-page":"735\u201347","article-title":"Efficacy and safety of long-acting pasireotide in Japanese patients with acromegaly or pituitary gigantism: results from a multicenter, open-label, randomized, phase 2 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\nL","year":"2014;"},{"issue":"(3):","key":"CIT0019","series-title":"Endocrine","first-page":"505\u201310","article-title":"De-escalation treatment with pasireotide for acromegaly: a long-term experience","volume":"80","author":"Giampietro\n \nA","year":"2023;"},{"issue":"(3):","key":"CIT0020","series-title":"J Clin Endocrinol Metab","first-page":"791\u20139","article-title":"Pasireotide versus octreotide in acromegaly: a head-to-head superiority study","volume":"99","author":"Colao\n \nA","year":"2014;"},{"issue":"(2):","key":"CIT0021","series-title":"J Clin Endocrinol Metab","first-page":"297\u2013308","article-title":"The future of somatostatin receptor ligands in acromegaly","volume":"107","author":"Gadelha\n \nMR","year":"2022;"},{"issue":"(12):","key":"CIT0022","series-title":"Endocr Connect","first-page":"1178\u201390","article-title":"Risk factors and management of pasireotide-associated hyperglycemia in acromegaly","volume":"9","author":"Gadelha\n 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