Effect of octreotide on endometriosis in acromegaly: Case report with review of literature
A 34-year-old female presented in the gynaecology outpatient department with complaints of menorrhagia and passage of clots along with abdominal pain which she had been experiencing for the last 13 years. Periods had been regular otherwise, lasting for about 5-6 days each month. USG pelvis revealed bilateral complex cystic adnexal masses with diffuse low level internal echoes. The left adnexal cyst was larger (6.5 × 6.0 cm) and multiloculated. The right adnexal cyst was unilocular and of size 3.5 × 2.8 cm []. MRI pelvis was done subsequently which revealed bilateral cysts, hyperintense on T1 and T1 fat suppressed images and hypointense with few hyperintense areas (shading) on T2WI and a diagnosis of endometriotic cysts was made [Figure and ]. She was advised to take oral contraceptives and NSAIDS. There was however no change in either the menstrual flow or clots with this therapy. She discontinued the therapy after two months.\nThree months later, she approached the doctor with additional complaints of diplopia and left sided temporal hemianopia. MRI brain was done, this revealed a pituitary macroadenoma. She was then referred to the department of Endocrinology for further assessment and management of macroadenoma. History and clinical features were suggestive of acromegaly. Post glucose load Growth Hormone levels were high (39.8 ng/ml). Prolactin levels were 70 ng/ml and freeT4 levels were low (freeT4-0.60 ug/dl (0.6-2.2), TSH-4.410 mIU/ml). Thyroxine supplementation was initiated. The patient underwent pituitary surgery, five months following which she underwent 25 sessions of radiotherapy (SRT). Menstrual problems persisted and she underwent dilatation and curettage followed by biopsy of the endometrium which was suggestive of endometrial hyperplasia.\nAs her IGF-1 levels were high even nine months post operatively, the patient was put on Injection Octreotide. (IGF1-710:Nomalrange 117-329 μg/L). Six months from the introduction of octreotide, the patient developed gallstones. During this period, the patient's menstrual flow had decreased from 5 to 3 days and there was a reduction in the amount of clots. Follow up ultrasound scans revealed a significant decrease in the size of the lesions over a period of one year with bilateral normal ovaries in the scans done at three years and subsequently []. She was continued on monthly octreotide injections. There was a gradual decline and normalisation of IGF-1 levels over a period of three years with this treatment []. Octreotide therapy was stopped after four years. Concurrently, there was a gradual improvement and normalisation of menstrual flow and pattern. Ultrasonography revealed bilateral normal ovaries. Presently, the patient is amenorrhoeic for the past 3 years. Hormonal profile was suggestive of hypogonadotropichypogonadism (LH-1.84 mIU/ml normal value range 0.8-15.5 mIU/ml in fertile females age group, FSH-7.03 mIU/ml normal value range 1.3-23.4 mIU/ml, E2-3.00 pmol/L (97.5-592 pmol/L), Progesterone -0.052 (0.44-6.47 nmol/L), Prl-15.2 ng/ml, normal value range 3-18.6 ng/ml.