TITLE:
Abducens nerve palsy during pegvisomant therapy in an acromegalic patient
AUTHORS:
Esra Hatipoglu, Hasan Kepicoglu, Emel Basar, Nurperi Gazioglu, Civan Islak, Sabahattin Saip, Pinar Kadioglu
KEYWORDS:
Acromegaly; Pegvisomant; Tumor Growth, Cavernous Sinus; Abduscence Nerve palsy
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.3 No.2,
June
10,
2013
ABSTRACT: Pegvisomant
is a recent treatment modality of acromegaly,
which is most effective in regulating IGF-1 levels. Tumor growth has been reported
in 5% of the acromegaly cases treated with pegvisomant. Herein we report a case
of acromegaly resistant to surgical treatment, radiotherapy and medical therapy
with a somatostatin analogue and cabergolin. Due to presence of pituitary tumor
with cavernous sinus invasion and unremitting disease activity pegvisomant
therapy was initiated. She developed left abducens nerve palsy after pegvisomant
treatment. The objective of this report is to emphasize the value of close follow-up
of the acromely cases under pegvisomant therapy, especially if they have cavernous
sinus infiltrating tumor. A 44-year-old woman with acromegaly presented with
visual defect and diplopia on left lateral gaze. Her complaint developed 3
years after initiation of pegvisomant therapy. Her neurologic examination was
consistent with mild abducens nerve palsy on left side. Other causes for
abducens nerve palsy were excluded. Pegvisomant was discontinued upon patient
request. Although sella MRI did not reveal a tumor growth, even minimal growth
within cavernous sinus can cause cranial nerve involvement. Therefore close
and careful follow-up of cavernous sinus infiltrating tumors after
pegvisomant therapy is crucial to early recognition of complications.