The Combination Therapy of Pasireotide LAR Plus Pegvisomant and Cabergoline Relieved Acromegaly-Related Headache in a Female Patient with AIP-Mutated Acromegaly: A Case Report.

Introduction: Acromegaly is a rare condition characterized by excessive exposure to GH and IGF-1 due to a pituitary adenoma in most cases. The disease is associated with numerous symptoms, including headaches, which are frequently difficult to manage.

Case presentation: We report the clinical history of an 11-year-old female patient with an AIP mutation and acromegaly, who was unresponsive to treatment with somatostatin receptor ligands and diagnosed with chronic, disabling headaches resistant to multiple treatments, such as indomethacin, cyclooxygenase-2 inhibitors, gabapentin, melatonin, topiramate, galcanezumab, and verapamil. The patient achieved biochemical control of acromegaly with a combination therapy using lanreotide autogel (Lanreotide ATG) and pegvisomant. However, due to persistent and disabling headaches, lanreotide ATG was discontinued, and combination therapy with pasireotide long-acting release (Pasireotide LAR) and pegvisomant was initiated, resulting in the resolution of the headache, with sustained improvement over time.

Conclusion: This case report highlights the potential benefits of pasireotide in the treatment of refractory headaches, particularly when combined with pegvisomant.  .