Pituitary

, Volume 17, Issue 3, pp 227–231

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

  • Jan Komor
  • Jean Claude Reubi
  • Emanuel R. Christ
Article

DOI: 10.1007/s11102-013-0494-0

Cite this article as:
Komor, J., Reubi, J.C. & Christ, E.R. Pituitary (2014) 17: 227. doi:10.1007/s11102-013-0494-0

Abstract

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.

Keywords

Non-functioning pituitary adenoma WHO II Peptide receptor radionuclide therapy Octreoscan Nervus oculomotorius Somatostatin receptors 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jan Komor
    • 1
  • Jean Claude Reubi
    • 2
  • Emanuel R. Christ
    • 3
  1. 1.BernSwitzerland
  2. 2.Cell Biology and Experimental Cancer Research, Institute of PathologyUniversity of BernBernSwitzerland
  3. 3.Division of Endocrinology, Diabetology and Clinical NutritionUniversity Hospital of Bern, InselspitalBernSwitzerland

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