Table 2 Therapeutic intervention and follow-up in patients with somatotropinoma
Patient | Genetic mutation | IGF1 (μg/L) and MRI at diagnosis | First-type therapy | Second-type therapy | Third-type therapy | Fourth-type therapy | Control of disease | Last IGF1 (μg/L) and MRI | F-U (Years) |
|---|---|---|---|---|---|---|---|---|---|
1 | MAS | 406 (+3SD) Hyperplasia 565 (+4SD) | Octreotide LAR 30 mg (monthly- 18 months) | + Cabergoline 1 mg/week | Pegvisomant 20 mg/day | C | 333 (-1SD) NA | 7 | |
2 | MENI | Invasive Macroadenoma (36 × 27 × 28 mm) 1259 (+4SD) | Trans-sphenoidal surgery | Octreotide LAR 30 mg monthly (6 months - growth of adenoma with visual disturbance; 3 surgeries) | + Cabergoline with visual (1 mg/week) | Proton therapy | NC | 689 (+2.5SD) 14 × 10 mm (-68%) | 3 |
3 | AIP | Invasive Macroadenoma (21 × 26 mm) 997 (+4SD) | Lanreotide LAR 90 mg monthly (6 months) | Octreotide LAR 30 mg monthly + cabergoline (1 mg/week) | Transphenoidal surgery | NC | 1184 (+4SD) 10 × 12 × 9 mm (-50%) | 4 | |
4 | AIP | Invasive Macroadenoma (16 × 21 × 11 mm) 934 (+4SD) | Lanreotide LAR 60 mg monthly (6 months) | Transphenoidal surgery | C | 451 (0SD) No visible adenoma | 6 | ||
5 | Negative genetic analysis (Carney, MEN1, AIP) | Non invasive macroadenoma (19 × 14 × 20 mm) | Lanreotide LAR 60 mg monthly | C | 282 (+1SD) No visible adenoma | 4 | |||
6 | Negative genetic analysis (MEN1, AIP) | 777 (+3SD) Invasive macroadenoma (26 × 26 × 32 mm) | Octreotide LAR 30 mg monthly (6 months) added to the previous Dopamine agonist treatment (Cabergoline 1,5 mg/week) | NC | 717(+3SD) 34 × 21 × 23 mm (+6%) | 2 | |||
7 | Negative genetic analysis (Carney, MEN1, AIP) | 574 (+4SD) Microadenoma (7,6 × 9 × 7,5 mm) | Trans-sphenoidal surgery | C | 504 (+1,5 SD) No visible adenoma | 4 |