Efficacy of pasireotide in controlling severe hypercortisolism until cardiac transplantation

Roberto Attanasio, Liana Cortesi, Daniela Gianola, Claudia Vettori, Fulvio Sileo, Roberto Trevisan

Research output: Contribution to journalArticle

Abstract

SUMMARY: Cushing's syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function. Physical examination showed severely impaired general status, signs of hypercortisolism and multiple vertebral compression fractures. We administered teriparatide, and the few evaluable parameters supported the diagnosis of ACTH-dependent hypercortisolism: serum cortisol was 24.2 µg/dL in the morning and 20.3 µg/dL after overnight 1 mg dexamethasone, urinary free cortisol (UFC) was 258 µg/24 h and ACTH 125 pg/mL. Pituitary CT was negative. Pasireotide 300 µg bid was administered and uptitrated to 600 µg bid. Treatment was well tolerated, achieving dramatic improvement of clinical picture with progressive normalization of serum cortisol and ACTH levels as well as UFC. After 4 months, the patient underwent successful heart transplantation. Many complications ensued and were overcome. Pituitary MRI was negative. On pasireotide 300 µg bid and prednisone 2.5 mg/day (as part of immunosuppressive therapy), morning serum cortisol and ACTH were 15.6 µg/dL and 54 pg/mL respectively, UFC was 37 µg/24 h, fasting glucose: 107 mg/dL and HbA1c: 6.5%. In conclusion, primary treatment with pasireotide achieved remission of hypercortisolism, thus allowing the patient to undergo heart transplantation.

LEARNING POINTS: Untreated Cushing's syndrome is associated with ominous prognosis.First-line treatment is surgery (at pituitary or adrenal, according to disease localization).A few drugs are available to treat hypercortisolism.Pasireotide is a multi-ligand somatostatin analog approved for treatment of hypercortisolism.Primary treatment with pasireotide was effective in a patient with severe Cushing's syndrome, allowing him to undergo heart transplantation.

Original languageEnglish
JournalEndocrinology, diabetes & metabolism case reports
Volume2017
DOIs
Publication statusPublished - 2017
Externally publishedYes

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Cushing Syndrome
Heart Transplantation
Hydrocortisone
Adrenocorticotropic Hormone
Therapeutics
Serum
Pharmaceutical Preparations
Teriparatide
pasireotide
Compression Fractures
Immunosuppressive Agents
Prednisone
Somatostatin
Cardiomyopathies
Dexamethasone
Physical Examination
Fasting
Ligands
Morbidity
Glucose

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Efficacy of pasireotide in controlling severe hypercortisolism until cardiac transplantation. / Attanasio, Roberto; Cortesi, Liana; Gianola, Daniela; Vettori, Claudia; Sileo, Fulvio; Trevisan, Roberto.

In: Endocrinology, diabetes & metabolism case reports, Vol. 2017, 2017.

Research output: Contribution to journalArticle

Attanasio, Roberto ; Cortesi, Liana ; Gianola, Daniela ; Vettori, Claudia ; Sileo, Fulvio ; Trevisan, Roberto. / Efficacy of pasireotide in controlling severe hypercortisolism until cardiac transplantation. In: Endocrinology, diabetes & metabolism case reports. 2017 ; Vol. 2017.
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abstract = "SUMMARY: Cushing's syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function. Physical examination showed severely impaired general status, signs of hypercortisolism and multiple vertebral compression fractures. We administered teriparatide, and the few evaluable parameters supported the diagnosis of ACTH-dependent hypercortisolism: serum cortisol was 24.2 µg/dL in the morning and 20.3 µg/dL after overnight 1 mg dexamethasone, urinary free cortisol (UFC) was 258 µg/24 h and ACTH 125 pg/mL. Pituitary CT was negative. Pasireotide 300 µg bid was administered and uptitrated to 600 µg bid. Treatment was well tolerated, achieving dramatic improvement of clinical picture with progressive normalization of serum cortisol and ACTH levels as well as UFC. After 4 months, the patient underwent successful heart transplantation. Many complications ensued and were overcome. Pituitary MRI was negative. On pasireotide 300 µg bid and prednisone 2.5 mg/day (as part of immunosuppressive therapy), morning serum cortisol and ACTH were 15.6 µg/dL and 54 pg/mL respectively, UFC was 37 µg/24 h, fasting glucose: 107 mg/dL and HbA1c: 6.5{\%}. In conclusion, primary treatment with pasireotide achieved remission of hypercortisolism, thus allowing the patient to undergo heart transplantation.LEARNING POINTS: Untreated Cushing's syndrome is associated with ominous prognosis.First-line treatment is surgery (at pituitary or adrenal, according to disease localization).A few drugs are available to treat hypercortisolism.Pasireotide is a multi-ligand somatostatin analog approved for treatment of hypercortisolism.Primary treatment with pasireotide was effective in a patient with severe Cushing's syndrome, allowing him to undergo heart transplantation.",
author = "Roberto Attanasio and Liana Cortesi and Daniela Gianola and Claudia Vettori and Fulvio Sileo and Roberto Trevisan",
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T1 - Efficacy of pasireotide in controlling severe hypercortisolism until cardiac transplantation

AU - Attanasio, Roberto

AU - Cortesi, Liana

AU - Gianola, Daniela

AU - Vettori, Claudia

AU - Sileo, Fulvio

AU - Trevisan, Roberto

PY - 2017

Y1 - 2017

N2 - SUMMARY: Cushing's syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function. Physical examination showed severely impaired general status, signs of hypercortisolism and multiple vertebral compression fractures. We administered teriparatide, and the few evaluable parameters supported the diagnosis of ACTH-dependent hypercortisolism: serum cortisol was 24.2 µg/dL in the morning and 20.3 µg/dL after overnight 1 mg dexamethasone, urinary free cortisol (UFC) was 258 µg/24 h and ACTH 125 pg/mL. Pituitary CT was negative. Pasireotide 300 µg bid was administered and uptitrated to 600 µg bid. Treatment was well tolerated, achieving dramatic improvement of clinical picture with progressive normalization of serum cortisol and ACTH levels as well as UFC. After 4 months, the patient underwent successful heart transplantation. Many complications ensued and were overcome. Pituitary MRI was negative. On pasireotide 300 µg bid and prednisone 2.5 mg/day (as part of immunosuppressive therapy), morning serum cortisol and ACTH were 15.6 µg/dL and 54 pg/mL respectively, UFC was 37 µg/24 h, fasting glucose: 107 mg/dL and HbA1c: 6.5%. In conclusion, primary treatment with pasireotide achieved remission of hypercortisolism, thus allowing the patient to undergo heart transplantation.LEARNING POINTS: Untreated Cushing's syndrome is associated with ominous prognosis.First-line treatment is surgery (at pituitary or adrenal, according to disease localization).A few drugs are available to treat hypercortisolism.Pasireotide is a multi-ligand somatostatin analog approved for treatment of hypercortisolism.Primary treatment with pasireotide was effective in a patient with severe Cushing's syndrome, allowing him to undergo heart transplantation.

AB - SUMMARY: Cushing's syndrome is associated with increased morbidity and mortality. Although surgery is the first-line treatment, drugs can still play a role as an ancillary treatment to be employed while waiting for surgery, after unsuccessful operation or in patients unsuitable for surgery. We were asked to evaluate a 32-year-old male waiting for cardiac transplantation. Idiopathic hypokinetic cardiomyopathy had been diagnosed since 6 years. He was on treatment with multiple drugs, had a pacemaker, an implantable cardioverter and an external device for the support of systolic function. Physical examination showed severely impaired general status, signs of hypercortisolism and multiple vertebral compression fractures. We administered teriparatide, and the few evaluable parameters supported the diagnosis of ACTH-dependent hypercortisolism: serum cortisol was 24.2 µg/dL in the morning and 20.3 µg/dL after overnight 1 mg dexamethasone, urinary free cortisol (UFC) was 258 µg/24 h and ACTH 125 pg/mL. Pituitary CT was negative. Pasireotide 300 µg bid was administered and uptitrated to 600 µg bid. Treatment was well tolerated, achieving dramatic improvement of clinical picture with progressive normalization of serum cortisol and ACTH levels as well as UFC. After 4 months, the patient underwent successful heart transplantation. Many complications ensued and were overcome. Pituitary MRI was negative. On pasireotide 300 µg bid and prednisone 2.5 mg/day (as part of immunosuppressive therapy), morning serum cortisol and ACTH were 15.6 µg/dL and 54 pg/mL respectively, UFC was 37 µg/24 h, fasting glucose: 107 mg/dL and HbA1c: 6.5%. In conclusion, primary treatment with pasireotide achieved remission of hypercortisolism, thus allowing the patient to undergo heart transplantation.LEARNING POINTS: Untreated Cushing's syndrome is associated with ominous prognosis.First-line treatment is surgery (at pituitary or adrenal, according to disease localization).A few drugs are available to treat hypercortisolism.Pasireotide is a multi-ligand somatostatin analog approved for treatment of hypercortisolism.Primary treatment with pasireotide was effective in a patient with severe Cushing's syndrome, allowing him to undergo heart transplantation.

U2 - 10.1530/EDM-16-0140

DO - 10.1530/EDM-16-0140

M3 - Article

VL - 2017

JO - Endocrinology, Diabetes and Metabolism Case Reports

JF - Endocrinology, Diabetes and Metabolism Case Reports

SN - 2052-0573

ER -