Acromegaly from ectopic growth hormone‐releasing hormone secretion by a malignant carcinoid tumor. Successful treatment with long‐acting somatostatin analogue SMS 201–995

Abstract

A 26‐year‐old man with acromegaly secondary to ectopic growth hormone‐releasing hormone (GHRH) secretion by a metastatic carcinoid tumor is the subject of this study. He previously failed to respond to conventional therapeutic modalities (partial hypophysectomy, pituitary irradiation, high‐dose bromocriptine and a combination of streptozotocin and 5‐fluorouracil) and was treated with long‐acting somatostatin analogue SMS 201–995 (Sandoz, East Hanover, NJ). Growth hormone and somatomedin C concentrations became normal, and GHRH‐LI (GHRH‐like immunoreactivity) was suppressed by more than 60%. The growth hormone response to exogenous GHRH 1–40 was stopped and growth hormone rise to thyrotropin‐releasing hormone (TRH) was significantly attenuated. A significant shrinkage of the pituitary gland was observed. Similarly, the size of the metastatic carcinoid lesions decreased dramatically and was accompanied by a normalization of liver function. After almost 2 years of SMS 201–995 therapy, the patient was well and had no clinical signs of acromegaly. Thus, SMS 201–995 appears to be a remarkably effective agent for treatment of acromegaly secondary to ectopic GHRH secretion. Copyright © 1988 American Cancer Society