This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Drange, M. R. Articles by Melmed, S. Search for Related Content PubMed PubMed Citation Articles by Drange, M. R. Articles by Melmed, S.

Long-Acting Lanreotide Induces Clinical and Biochemical Remission of Acromegaly Caused by Disseminated Growth Hormone-Releasing Hormone-Secreting Carcinoid

Division of Endocrinology and Metabolism, Cedars-Sinai Research Institute, University of California School of Medicine, Los Angeles, California 90048

Address all correspondence and requests for reprints to: Shlomo Melmed, M.D., Division of Endocrinology and Metabolism, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, B-131, Los Angeles, California 90048. E-mail: melmed{at}cshs.org

Ectopic GHRH-secreting tumors, such as carcinoid, rarely cause acromegaly. As protracted exposure to high levels of GH is associated with considerable morbidity and mortality, these patients require early and effective medical therapy to control hormonal hypersecretion. We employed a prolonged release somatostatin analog, lanreotide, to treat a patient with disseminated GHRH-producing carcinoid. Before treatment, the patient had a biochemical profile characteristic of active acromegaly. Plasma GHRH levels were markedly elevated (200-fold), and urinary 5-hydroxyindolacetic acid (5-HIAA) levels were increased (4-fold). Magnetic resonance imaging revealed a large asymmetrical pituitary mass consistent with somatotroph hyperplasia. Somatostatin receptor scintigraphy revealed multiple bony and soft tissue lesions as well as striking pituitary uptake. Lanreotide (30 mg) was administered weekly by im injection for 12 weeks. Rapid and sustained symptomatic clinical improvement with diminished soft tissue swelling and hyperhidrosis was observed. GHRH levels decreased by 70%; glucose-suppressed GH and insulin-like growth factor I levels were reduced by 90% and 75%, respectively, to near normal values; urinary 5-HIAA levels normalized; and the pituitary mass remained unchanged. Unfortunately, the patient died due to complications of osteogenic sarcoma. In conclusion, prolonged release lanreotide induced clinical and biochemical remission in this patient with diffusely metastatic GHRH-producing carcinoid. This long-acting drug thus offers an effective, well tolerated, and convenient medical therapy for control of hormonal hypersecretion induced by excess GHRH.

This article has been cited by other articles:

				C. G. Ziegler, J. W. Brown, A. V. Schally, A. Erler, L. Gebauer, A. Treszl, L. Young, L. M. Fishman, J. B. Engel, H. S. Willenberg, et al. Expression of neuropeptide hormone receptors in human adrenal tumors and cell lines: Antiproliferative effects of peptide analogues PNAS, September 15, 2009; 106(37): 15879 - 15884. [Abstract] [Full Text] [PDF]

				S. Biswal, B. Srinivasan, P. Dutta, P. Ranjan, K. Vaiphei, R. S. Singh, and S. S. Thingnam Acromegaly Caused by Ectopic Growth Hormone: A Rare Manifestation of a Bronchial Carcinoid Ann. Thorac. Surg., January 1, 2008; 85(1): 330 - 332. [Abstract] [Full Text] [PDF]

				M. C. Zatelli, P. Maffei, D. Piccin, C. Martini, F. Rea, D. Rubello, A. Margutti, M. D. Culler, N. Sicolo, and E. C. d. Uberti Somatostatin Analogs in Vitro Effects in a Growth Hormone-Releasing Hormone-Secreting Bronchial Carcinoid J. Clin. Endocrinol. Metab., April 1, 2005; 90(4): 2104 - 2109. [Abstract] [Full Text] [PDF]

				S.-G. Ren, J. Taylor, J. Dong, R. Yu, M. D. Culler, and S. Melmed Functional Association of Somatostatin Receptor Subtypes 2 and 5 in Inhibiting Human Growth Hormone Secretion J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4239 - 4245. [Abstract] [Full Text] [PDF]

				Z Merza Modern treatment of acromegaly Postgrad. Med. J., April 1, 2003; 79(930): 189 - 194. [Abstract] [Full Text] [PDF]

				A. Bhansali, S S. Rana, S. Bhattacharya, R. Muralidharan, R. J Dash, and A. K Banerjee Acromegaly: a Rare Manifestation of Bronchial Carcinoid Asian Cardiovasc Thorac Ann, September 1, 2002; 10(3): 273 - 274. [Abstract] [Full Text] [PDF]

				H. G. Maheshwari, T. R. Prezant, V. Herman-Bonert, H. Shahinian, K. Kovacs, and S. Melmed Long-Acting Peptidomimergic Control of Gigantism Caused by Pituitary Acidophilic Stem Cell Adenoma J. Clin. Endocrinol. Metab., September 1, 2000; 85(9): 3409 - 3416. [Abstract] [Full Text]

				A. Giustina, A. Barkan, F. F. Casanueva, F. Cavagnini, L. Frohman, K. Ho, J. Veldhuis, J. Wass, K. von Werder, and S. Melmed Criteria for Cure of Acromegaly: A Consensus Statement{dagger} J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 526 - 529. [Abstract] [Full Text]

				A. Van den Bruel, J. Fevery, J. Van Dorpe, L. Hofland, and R. Bouillon Hormonal and Volumetric Long Term Control of a Growth Hormone-Releasing Hormone-Producing Carcinoid Tumor J. Clin. Endocrinol. Metab., September 1, 1999; 84(9): 3162 - 3169. [Full Text]

				J. Krassowski, W. Zgliczynski, W. Jeske, and S. Zgliczynski Comment on Long-Acting Lanreotide Inducing Clinical and Biochemical Remission of Acromegaly Caused by Disseminated GHRH Secreting Carcinoid J. Clin. Endocrinol. Metab., May 1, 1999; 84(5): 1761a - 1762. [Full Text]