A 50-year-old woman with acromegaly presented with persistent sweating and headaches despite having undergone trans-sphenoidal surgery and pituitary radiotherapy 2 years
previously. She had been intolerant of treatment with octreotide.
Investigations:
serum growth hormone11.1 ?g/L (<0.4)
serum insulin-like growth factor 186.2 nmol/L (5.6C23.3)
Following imaging, it was judged that there was no role for repeat surgery. She was treated with pegvisomant 10 mg. Six months into treatment, her symptoms had improved.
Investigations (6 months later):
serum growth hormone20.3 ?g/L (<0.4)
serum insulin-like growth factor 115.2 nmol/L (5.6C23.3)
What is the most appropriate next step in management?
A . add cabergoline
B . arrange another full course of pituitary radiotherapy
C . continue present dosage of pegvisomant
D . increase dosage of pegvisomant
E . stop pegvisomant
Answer: C
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