Peptide receptor radionuclide therapy in a patient with disabling non-functioning pituitary adenoma

Komor, Jan; Reubi, Jean-Claude; Christ, Emanuel R. (2014). Peptide receptor radionuclide therapy in a patient with disabling non-functioning pituitary adenoma. Pituitary, 17(3), pp. 227-231. Springer Science + Business Media 10.1007/s11102-013-0494-0

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Non-functioning pituitary adenoma (NFPA) with higher proliferation index (WHO II) are often a therapeutical challenge. Low somatostatin receptor expression in these tumors usually prevents a treatment with somatostatin analogs. In 1996, a 55-year-old patient was referred due to right-sided headache. A pituitary macroadenoma with infiltration into the right cavernous sinus was diagnosed. There was no visual field deficit and the clinical and biochemical work up was consistent with a NFPA. The patient underwent transsphenoidal surgery. Residual adenoma remained in the right cavernous sinus. Histologically, a null-cell adenoma with a high proliferation index was documented (MIB-1: 11.6 %, WHO II). Somatostatin receptor autoradiography was performed in the surgical specimen showing a homogenous expression of sst2 receptors. Radiosurgery was completed with stable disease for 8 years. In 2004, the patient was diagnosed with an incomplete palsy of the right oculomotorius nerve and a significant increase in the volume of the adenoma in the right cavernous sinus. After a positive Octreoscan(®) the patient consented to an experimental therapy approach using Lutetium DOTATOC (3 × 200 mCi). The palsy of the oculomotorius nerve improved and remained stable until today (March 2013), the follow-up MRI scans demonstrated stable disease. This is the first case of a patient with a NFPA (WHO II) in whom PRRT successfully improved the local complications of the tumor for more than 8 years after ineffective surgery and gamma knife therapy. The determination of sst2 in vitro using autoradiography and in vivo by Octreoscan was instrumental to administer this therapy in a challenging situation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

UniBE Contributor:

Reubi-Kattenbusch, Jean-Claude and Christ, Emanuel

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

1386-341X

Publisher:

Springer Science + Business Media

Language:

English

Submitter:

Andrea Arnold

Date Deposited:

02 Apr 2014 16:56

Last Modified:

10 Oct 2019 14:30

Publisher DOI:

10.1007/s11102-013-0494-0

PubMed ID:

23740146

BORIS DOI:

10.7892/boris.46332

URI:

https://boris.unibe.ch/id/eprint/46332

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