[Multidisciplinary approach to the treatment of aggressive hormone releasing adenoma: a case report and literature review].

Abstract

Background: Despite available modern therapeutic options for acromegaly, resistant and aggressive forms of growth hormone releasing adenoma remain a significant clinical challenge with unsatisfactory outcomes.

Material and methods: The authors present a young patient with invasive growth hormone releasing adenoma characterized by aggressive growth, high proliferation index and previously unreported TP53 gene mutation, PD-L1 and VEGF expression, resistance to somatostatin analogues and no disease control despite combined therapy including growth hormone receptor antagonist.

Results: A patient with aggressive somatotropinoma experienced tumor growth despite previous neurosurgical interventions, radio- and chemotherapy, as well as targeted therapy. External beam radiation therapy is recommended as the only treatment option. The authors also examine aspects of multidisciplinary approach, results of antiangiogenic, chemo- and immunotherapy with immune checkpoint inhibitors when neurosurgery, traditional medications, and radiotherapy are ineffective.

Conclusion: This case underscores the necessity of extended immunohistochemical profiling and molecular genetic sequencing of pituitary tumors to facilitate development of personalized therapeutic strategies for aggressive somatotropinomas refractory to standard treatment modalities.