Growth hormone–secreting macroadenoma of the pituitary gland successfully treated with the radiolabeled somatostatin analog 90Y-DOTATATE: case report

Abstract

Pituitary tumors causing acromegaly are usually macroadenomas at the time of diagnosis, and they can grow aggressively, infiltrating surrounding tissues. Difficulty in achieving complete tumor removal at surgery can lead toward a strong tendency for recurrence, making it necessary to consider a means of treatment other than those currently used such as somatostatin analogs (SSAs), growth hormone (GH) receptor antagonist, surgical removal, and radiotherapy. The purpose of this paper is to describe a patient diagnosed with an aggressive, giant GH-secreting tumor refractory to medical therapy but ultimately treated with the radiolabeled somatostatin analog 90Y-DOTATATE. A 26-year-old male with an invasive macroadenoma of the pituitary gland (5.6 × 2.5 × 3.6 cm) and biochemically confirmed acromegaly underwent 2 partial tumor resections: the first used the transsphenoidal approach and the second used the transcranial method. The patient received SSAs pre- and postoperatively. Because of the progression in pituitary tumor size, he underwent classic irradiation of the tumor (50 Gy). One and a half years later, the patient presented with clinically and biochemically active disease, and the tumor size was still 52 mm in diameter (height). Two neurosurgeons disqualified him from further surgical procedures. After confirming the presence of somatostatin receptors in the pituitary tumor by using 68Ga-DOTATATE PET/CT, we treated the patient 4 times with an SSA bound with 90Y-DOTATATE. After this treatment, the patient attained partial biochemical remission and a reduction in the tumor mass for the first time. Treatment with an SSA bound with 90Y-DOTATATE may be a promising option for some aggressive GH-secreting pituitary adenomas when other methods have failed.

Management of Aggressive Pituitary Tumors – A 2019 Update

“…The patient received 3 cycles of 177 Lu-DOTATATE (7.4 GBq each cycle), and subsequently remained stable during the follow-up of 4 years. Waligórska-Stachura et al presented a 26-year male with a giant GH-secreting pituitary adenoma, with uncontrolled disease despite prior transsphenoidal and transcranial surgery, medical treatment with SLR, and radiation therapy [70]. After confirming somatostatin receptor expression by 68 Ga-DOTATATE PET/CT, he was treated with 4 cycles of 90 Yttrium-DOTATATE (100 mCi every 3 months), with subsequent tumor regression and biochemical control during follow-up of 12 months.…”

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

“…Patients received 2-4 cycles. Two patients demonstrated significant tumour shrinkage on treatment but one did not have a hormonal response (164,168). Three patients have been reported to have stable disease with follow-up of 1 year and 3.5 years in 2 of these patients (165,166,167).…”

“…Tumour uptake was assessed by octreoscan or 68Ga-DOTATATE PET/CT. Four patients were treated with 111Indium-DPTAoctreotide (164,165), 4 with 177Lutetium DOTATATE (25,166,167), 3 with 90Yttrium-DOTATOC (25,168,169) and 3 with 177Lutetium DOTATOC (11,25). Patients received 2-4 cycles.…”

<p>Resolution of Long-Standing Diabetes Mellitus Two Years After Surgery for Growth Hormone Producing Pituitary Tumor</p>

“…13 Treatment with somatostatin analogs bound with 90 Y-DOTATATE maybe an option for aggressive tumors not responding to other methods. 15…”