Long-term Effects of Octreotide on Pituitary Gigantism: Its Analgesic Action on Cluster Headache

Abstract

Abstract. We report the case of 19-year-old man with pituitary gigantism due to growth hormone-producing pituitary macroadenoma. The patient complained of recurrent headache and excessive growth spurt since age 15. Octreotide administration was initiated following transsphenoidal pituitary adenomectomy. Octreotide injection for 4 years efficaciously reduced the size of remnant adenoma as well as serum growth hormone levels. Notably, octreotide exhibited a potent analgesic effect on his intractable cluster headache that has continued even after reduction of the adenoma volume. The analgesic effect lasted 2 to 6 hours after each injection and no tachyphylaxis to octreotide appeared during 4-year treatment. To characterize the headache and the pain intensity, analgesic drugs including octreotide, lidocaine, morphine and thiopental were tested using a visual analogue scale (VAS) evaluation, with the result that octreotide exhibited a prompt and complete disappearance of the headache. Headache relief was in part reproduced by morphine injection (56% reduction) but not by lidocaine or thiopental. The present case suggests that the intractable headache associated with pituitary gigantism is possibly related to the endogenous opioid system. Thus, the headache control by octreotide is clinically helpful for continuation of the self-injection regimen.

Chronic Cluster-Like Headache Secondary to Prolactinoma: Uncommon Cephalalgia in Association with Brain Tumors

“…16 There are currently no known factors that predict responsiveness to oxygen and sumatriptan treatments, although the tumor itself could be responsible for unresponsiveness. Our patient obtained complete pain relief from 10 mg of SC morphine, which is in line with observations by Otsuka et al 17 who reported partial analgesic effect of 3 mg of IV morphine in a young man with a cluster headache in association with pituitary gigantism. 17 Notwithstanding that our data are from one patient, it suggests that morphine may be useful as a treatment of cluster headache attacks in patients who are unresponsive to oxygen, triptan, or octreotide.…”

“…Our patient obtained complete pain relief from 10 mg of SC morphine, which is in line with observations by Otsuka et al 17 who reported partial analgesic effect of 3 mg of IV morphine in a young man with a cluster headache in association with pituitary gigantism. 17 Notwithstanding that our data are from one patient, it suggests that morphine may be useful as a treatment of cluster headache attacks in patients who are unresponsive to oxygen, triptan, or octreotide. However, we do not know why morphine differed from OTF in analgesic effect.…”

A Rare Case of Adult-onset Nesidioblastosis Treated Successfully with Diazoxide

“…Octreotide is a somatostatin analogue used for the treatment of endocrine tumors principally to suppress hormone release and inhibit tumor growth hormone-secreting tumors [19]. The beneficial effects of octreotide are recognized in acromegaly caused by pituitary adenomas [20], chronic headache associated with pituitary gigantism [21], pancreatic islet-cell tumors and carcinoid tumors [22]. Unfortunately, it was not useful in this case.…”

Successful Long-term Treatment with Once-daily Injection of Low-dose Octreotide in an Aged Patient with Insulinoma

“…Octreotide is a somatostatin analogue that inhibits the secretion of various peptide hormones such as GH. Octreotide displays high affinity for somatostatin receptor (SSTR) subtypes 2, 3 and 5, and is highly effective against tumors with these SSTR subtypes [2,3].…”