The online version of this article (doi:10.1186/1752-1947-6-2) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
VR and SR designed the study. VR, SR and CC performed the clinical examinations. LZ and VR analyzed the data according to the literature and wrote the first draft of the manuscript. CD, SR, VR and LZ contributed to the final version of the manuscript. CC supervised the entire work. All authors read and approved the final manuscript.
Pegvisomant-related lipohypertrophy may revert when changing the site of injection, but the lipohypertrophy may recur at the new site of injection. The strength of evidence, however, is weak and comes from information obtained from physical examination only.
We studied two Caucasian women with acromegaly, aged 51 and 71 years, with pegvisomant-related lipohypertrophy. Our two patients were evaluated at baseline, when the site of pegvisomant injection was the periumbilical abdominal region, and then four months after switching the injection site from the abdomen to both thighs. Both physical examination and radiological studies (magnetic resonance imaging and dual energy X-ray absorptiometry) demonstrated that the abdominal lipohypertrophy progressively reverted in both patients after switching the site of injection to the thighs. However, lipohypertrophy reappeared at the new site of injection. The radiological outcome confirmed the reversibility of pegvisomant-related lipohypertrophy and strengthened the body of evidence on this issue.
In clinical practice, physical examination of the injection site or sites leads to an early detection of lipohypertrophy during pegvisomant treatment. Radiological procedures may be of help to confirm subcutaneous fat changes and for a precise monitoring of fat redistribution. Patients should get appropriate information about lipohypertrophy before starting pegvisomant treatment since the rotation of the site of injection may prevent lipohypertrophy.
Higham C, Chung T, Lawrance J, Drake WM, Trainer PJ: Long term experience of pegvisomant therapy as a treatment for acromegaly. Clin Endocrinol. 2009, 71: 86-91. 10.1111/j.1365-2265.2008.03469.x. CrossRef
Marazuela M, Lucas T, Alvarez-Escolá C, Puig-Domingo M, de la Torre NG, de Miguel-Novoa P, Duran-Hervada A, Manzanares R, Luque-Ramírez M, Halperin I, Casanueva FF, Bernabeu I: Long-term treatment of acromegalic patients resistant to somatostatin analogues with the GH receptor antagonist pegvisomant: its efficacy in relation to gender and previous radiotherapy. Eur J Endocrinol. 2009, 160: 535-542. CrossRefPubMed
Schreiber I, Buchfelder M, Droste M, Forssmann K, Mann K, Saller B, Strasburger CJ, the German Pegvisomant Investigators: Treatment of acromegaly with the GH receptor antagonist pegvisomant in clinical practice: safety and efficacy evaluation from the German Pegvisomant Observational Study. Eur J Endocrinol. 2007, 156: 75-82. 10.1530/eje.1.02312. CrossRefPubMed
Buchfelder M, Weigel D, Droste M, Mann K, Saller B, Brübach K, Stalla GK, Bidlingmaier M, Strasburger CJ, Investigators of German Pegvisomant Observational Study: Pituitary tumor size in acromegaly during pegvisomant treatment: experience from MR re-evaluations of the German Pegvisomant Observational Study. Eur J Endocrinol. 2009, 161: 27-35. 10.1530/EJE-08-0910. CrossRefPubMed
- Clinical and radiological evidence of the recurrence of reversible pegvisomant-related lipohypertrophy at the new site of injection in two women with acromegaly: a case series
- BioMed Central