Limits...
Severe scalp hair loss in a female patient with acromegaly treated with lanreotide autogel after unsuccessful surgery.

Alvarez-Escola C, Cárdenas-Salas JJ, Pelegrina B, Sanz-Valtierra A, Lecumberri B - Clin Case Rep (2015)

Bottom Line: Scalp hair loss is an underreported adverse event of somatostatin analogs therapy that in severe cases may require treatment withdrawal.It can be related to an acute decrease in GH/IGF-1 levels, but a direct effect cannot be ruled out.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain.

ABSTRACT
Scalp hair loss is an underreported adverse event of somatostatin analogs therapy that in severe cases may require treatment withdrawal. It can be related to an acute decrease in GH/IGF-1 levels, but a direct effect cannot be ruled out.

No MeSH data available.


IGF-1 and GH levels before and after Lanreotide Autogel (LA) treatment. Hair loss represented in percentage as referred by the patient. Week “0” and “8” indicates the moment of administration of first and second LA doses (Arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4641480&req=5

fig03: IGF-1 and GH levels before and after Lanreotide Autogel (LA) treatment. Hair loss represented in percentage as referred by the patient. Week “0” and “8” indicates the moment of administration of first and second LA doses (Arrows).

Mentions: An endoscopic transsphenoidal surgery (TS) was performed and histopathologic study confirmed a pituitary adenoma with GH- and PRL-positive immunohistochemistry. Two months later IGF-1 levels were still high (993 μg/L), and no GH suppression, after a 75-gr oral glucose tolerance test (OGTT), was observed (Basal GH: 8.66; GH-Nadir: 6.82 μg/L). LA, at a dose of 120 mg every 56 days, was then prescribed. She reported abdominal discomfort and diarrhea within the first 15 days of treatment, with no other signs or symptoms. An excellent biochemical response was found after 111 days of treatment (IGF-1: 221 μg/L; GH: 0.48 μg/L), but 4 days after the second dose, she noticed a progressive diffuse scalp hair loss (Figs. 2). We ruled out other causes of alopecia: testosterone, DHEAs (Dehydroepiandrosterone sulfate), 17-OH progesterone, and thyroid hormone levels were normal, and no signs of infection were present in the scalp. After examination, we concluded that she had a nonscarring diffuse hair loss, affecting the scalp globally, and more compatible with Telogen effluvium. There was no evident loss of brows, lashes, or body hair. The intensity of hair loss increased, and psychological disturbances related to these new appearance changes obliged us to suspend the treatment, such that the third or subsequent doses were not administered. A new MRI showed remains of adenoma 6 months after the first TS. IGF-1 levels rose again, and hair loss improved considerably 5 months later, without any other treatment than LA withdrawal (Fig. 3). The disease persisted active (IGF-1: 775 μg/L; GH-nadir 1.98 μg/L after a 75-gr OGTT) after a second endoscopic TS, although no remains of adenoma were found in a postsurgical pituitary MRI. Cabergoline in increasing doses was then prescribed, showing a slow decrease in IGF-1 and GH levels. A complete biochemical response was achieved after 18 months of cabergoline therapy (IGF-1: 230 μg/L; GH 1.4 μg/L) and hair loss reappeared coinciding with the increase in cabergoline dose, however, it was not as severe as in case of Lanreotide treatment.


Severe scalp hair loss in a female patient with acromegaly treated with lanreotide autogel after unsuccessful surgery.

Alvarez-Escola C, Cárdenas-Salas JJ, Pelegrina B, Sanz-Valtierra A, Lecumberri B - Clin Case Rep (2015)

IGF-1 and GH levels before and after Lanreotide Autogel (LA) treatment. Hair loss represented in percentage as referred by the patient. Week “0” and “8” indicates the moment of administration of first and second LA doses (Arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4641480&req=5

fig03: IGF-1 and GH levels before and after Lanreotide Autogel (LA) treatment. Hair loss represented in percentage as referred by the patient. Week “0” and “8” indicates the moment of administration of first and second LA doses (Arrows).
Mentions: An endoscopic transsphenoidal surgery (TS) was performed and histopathologic study confirmed a pituitary adenoma with GH- and PRL-positive immunohistochemistry. Two months later IGF-1 levels were still high (993 μg/L), and no GH suppression, after a 75-gr oral glucose tolerance test (OGTT), was observed (Basal GH: 8.66; GH-Nadir: 6.82 μg/L). LA, at a dose of 120 mg every 56 days, was then prescribed. She reported abdominal discomfort and diarrhea within the first 15 days of treatment, with no other signs or symptoms. An excellent biochemical response was found after 111 days of treatment (IGF-1: 221 μg/L; GH: 0.48 μg/L), but 4 days after the second dose, she noticed a progressive diffuse scalp hair loss (Figs. 2). We ruled out other causes of alopecia: testosterone, DHEAs (Dehydroepiandrosterone sulfate), 17-OH progesterone, and thyroid hormone levels were normal, and no signs of infection were present in the scalp. After examination, we concluded that she had a nonscarring diffuse hair loss, affecting the scalp globally, and more compatible with Telogen effluvium. There was no evident loss of brows, lashes, or body hair. The intensity of hair loss increased, and psychological disturbances related to these new appearance changes obliged us to suspend the treatment, such that the third or subsequent doses were not administered. A new MRI showed remains of adenoma 6 months after the first TS. IGF-1 levels rose again, and hair loss improved considerably 5 months later, without any other treatment than LA withdrawal (Fig. 3). The disease persisted active (IGF-1: 775 μg/L; GH-nadir 1.98 μg/L after a 75-gr OGTT) after a second endoscopic TS, although no remains of adenoma were found in a postsurgical pituitary MRI. Cabergoline in increasing doses was then prescribed, showing a slow decrease in IGF-1 and GH levels. A complete biochemical response was achieved after 18 months of cabergoline therapy (IGF-1: 230 μg/L; GH 1.4 μg/L) and hair loss reappeared coinciding with the increase in cabergoline dose, however, it was not as severe as in case of Lanreotide treatment.

Bottom Line: Scalp hair loss is an underreported adverse event of somatostatin analogs therapy that in severe cases may require treatment withdrawal.It can be related to an acute decrease in GH/IGF-1 levels, but a direct effect cannot be ruled out.

View Article: PubMed Central - PubMed

Affiliation: Endocrinology Department, La Paz University Hospital Paseo de La Castellana 261, 28046 Madrid, Spain.

ABSTRACT
Scalp hair loss is an underreported adverse event of somatostatin analogs therapy that in severe cases may require treatment withdrawal. It can be related to an acute decrease in GH/IGF-1 levels, but a direct effect cannot be ruled out.

No MeSH data available.