Case Report: Neurosurgery, octreotide, cabergoline, radiotherapy, pasireotide and pegvisomant – a multimodal strategy for adolescent acrogigantism
4 affiliations
- 1Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw
- 2Department of Endocrinology and Diabetology, The Children’s Memorial Health Institute
- 3Department of Neurosurgery, Military Institute of Medicine
- 4Department of Department of Cancer Pathomorphology, Maria Sklodowska-Curie National Research Institute of Oncology
Abstract
Growth hormone (GH)-secreting pituitary neuroendocrine tumors (PitNETs) are rare in the pediatric population. They often present as large, invasive tumors and are frequently associated with an underlying genetic predisposition, making their management particularly challenging. Optimal treatment requires an individualized multidisciplinary approach, which often involves a combination of surgery and adjuvant medical therapy or radiotherapy when necessary. We present a challenging case of an adolescent female with acrogigantism. The patient was diagnosed at the age of 13 years and 10 months during the evaluation of chronic headaches. Brain magnetic resonance imaging revealed an invasive PitNET measuring 38 × 23 × 32 mm, while biochemical assessment confirmed marked GH hypersecretion. The disease followed an aggressive course, and biochemical control could not be achieved despite optimal multimodal therapy. Sequential treatment included neurosurgical resection, octreotide LAR, cabergoline, pasireotide LAR, proton beam radiotherapy, and pegvisomant. Combination therapy with pegvisomant and octreotide LAR ultimately normalized insulin-like growth factor 1 concentrations while maintaining long-term radiological tumor stability. This case underscores the complexity of managing aggressive GH-secreting PitNETs in adolescents and emphasizes the need for individualized, multidisciplinary care and long-term follow-up. Combined medical therapy with pegvisomant and octreotide LAR may provide effective biochemical control when surgery, radiotherapy, and standard medical treatment are insufficient.
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BibTeX
@article{dzialach2026case,
title = {{Case Report: Neurosurgery, octreotide, cabergoline, radiotherapy, pasireotide and pegvisomant – a multimodal strategy for adolescent acrogigantism}},
author = {Lukasz Dzialach and Agnieszka Bogusz-Wójcik and Elzbieta Moszczyńska and Agnieszka Wojciechowska-Luzniak and Grzegorz Zieliński and Maria Maksymowicz and Przemysław Witek},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1954698},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1954698/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Neurosurgery, octreotide, cabergoline, radiotherapy, pasireotide and pegvisomant – a multimodal strategy for adolescent acrogigantism
AU - Lukasz Dzialach
AU - Agnieszka Bogusz-Wójcik
AU - Elzbieta Moszczyńska
AU - Agnieszka Wojciechowska-Luzniak
AU - Grzegorz Zieliński
AU - Maria Maksymowicz
AU - Przemysław Witek
PY - 2026
DA - 2026/10/20
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1954698
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1954698/full
AB - Growth hormone (GH)-secreting pituitary neuroendocrine tumors (PitNETs) are rare in the pediatric population. They often present as large, invasive tumors and are frequently associated with an underlying genetic predisposition, making their management particularly challenging. Optimal treatment requires an individualized multidisciplinary approach, which often involves a combination of surgery and adjuvant medical therapy or radiotherapy when necessary. We present a challenging case of an adolescent female with acrogigantism. The patient was diagnosed at the age of 13 years and 10 months during the evaluation of chronic headaches. Brain magnetic resonance imaging revealed an invasive PitNET measuring 38 × 23 × 32 mm, while biochemical assessment confirmed marked GH hypersecretion. The disease followed an aggressive course, and biochemical control could not be achieved despite optimal multimodal therapy. Sequential treatment included neurosurgical resection, octreotide LAR, cabergoline, pasireotide LAR, proton beam radiotherapy, and pegvisomant. Combination therapy with pegvisomant and octreotide LAR ultimately normalized insulin-like growth factor 1 concentrations while maintaining long-term radiological tumor stability. This case underscores the complexity of managing aggressive GH-secreting PitNETs in adolescents and emphasizes the need for individualized, multidisciplinary care and long-term follow-up. Combined medical therapy with pegvisomant and octreotide LAR may provide effective biochemical control when surgery, radiotherapy, and standard medical treatment are insufficient.
SN - 1664-2392
ER -