Departmental Papers (Dental)

Document Type

Journal Article

Date of this Version

8-1-2006

Publication Source

The Journal of Clinical Endocrinology & Metabolism

Volume

91

Issue

8

Start Page

2960

Last Page

2966

DOI

10.1210/jc.2005-2661

Abstract

Context: GH excess affects approximately 20% of the patients with McCune-Albright syndrome (MAS). MAS is caused by sporadic, postzygotic, activating mutations in the GNAS gene, which codes for the cAMP-regulating protein, Gsα (gsp oncogene). These same mutations are found in approximately one third of the sporadic cases of acromegaly.

Objective: We examined efficacy of the GH receptor antagonist, pegvisomant, in controlling gsp oncogene-mediated GH excess and skeletal disease (fibrous dysplasia of bone) associated with MAS.

Setting and Patients: Five MAS patients with GH excess were treated with 20 mg/d sc injection of pegvisomant for 12 wk in a randomized, double-blind, placebo-controlled crossover study at the National Institutes of Health.

Main Outcome Measures: The primary measure of efficacy was normalization of IGF-I. Secondary outcome measures were reduction in serum IGF binding protein-3 (IGFBP-3), improvement of fatigue and sweating, and reduction in markers of bone metabolism and bone pain.

Results: Combined mean changes in serum IGF-I at 6 and 12 wk were −236.4 ng/ml (53%, P < 0.005) and −329.8 ng/ml (62%, P < 0.001), respectively. IGFBP-3 decreased by 0.8 mg/liter (24%, P < 0.01) and 2.9 mg/liter (37%, P < 0.005), respectively. There were no significant changes in signs and symptoms of acromegaly or markers of bone metabolism and bone pain, nor was there a significant change in pituitary size. Retrospective comparison of the degree of control achieved with pegvisomant vs. other medications (long-acting octreotide ± dopamine agonist) in the same group showed that the two regimens were similarly effective.

Conclusions: Pegvisomant effectively reduced IGF-I and IGFBP-3 levels in gsp-mediated GH excess but had no effect on fibrous dysplasia.

Copyright/Permission Statement

This is a pre-copyedited, author-produced PDF of an article accepted for publication in [The Journal of Clinical Endocrinology & Metabolism] following peer review. The version of record [Sunday O. Akintoye, Marilyn H. Kelly, Beth Brillante, Natasha Cherman, Sarah Turner, John A. Butman, Pamela G. Robey, Michael T. Collins; Pegvisomant for the Treatment of gsp-Mediated Growth Hormone Excess in Patients with McCune-Albright Syndrome, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 8, 1 August 2006, Pages 2960–2966, https://doi.org/10.1210/jc.2005-2661] is available online at: https://doi.org/10.1210/jc.2005-2661.

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Date Posted: 01 March 2022

This document has been peer reviewed.