A 35-year-old man with a pituitary macroadenoma (2.5 cm) has IGF-1 three times the upper limit of normal, GH nadir of 2.1 ng/mL after oral glucose tolerance test, and normal prolactin. He undergoes transsphenoidal surgery but postoperative IGF-1 remains elevated. Which medical therapy is the FIRST-LINE adjunct?
- A Pegvisomant
- B Octreotide LAR (somatostatin analogue) ✓
- C Cabergoline
- D Temozolomide
Correct answer: B. Octreotide LAR (somatostatin analogue)
Explanation
Somatostatin analogues (octreotide LAR, lanreotide) are first-line medical therapy for persistent acromegaly after surgery; they normalise IGF-1 in approximately 50-70% of patients and reduce tumour volume. Pegvisomant is a GH receptor antagonist reserved for patients unresponsive or intolerant to SSAs. Cabergoline has modest efficacy and is only used when IGF-1 is mildly elevated or if there is co-secretion of prolactin. Temozolomide is for aggressive or malignant pituitary tumours.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.