A Case of Acromegaly With Parasellar Meningioma With Oculomotor Palsy Responding to and Maintained With Oral Octreotide Therapy.

Background/Objective: Meningiomas are the most frequently occurring primary central nervous system tumors. Recommended treatment options for large, growing, or symptomatic meningiomas typically involve surgical removal (when possible) and/or radiation therapy. There is no sufficient evidence of effective systemic therapies for recurrent meningioma. Case Report: A 65-year-old female, after 20 years of stability with acromegaly, presented to the emergency department with a sudden onset of blurring of vision and was found to have severe left oculomotor nerve palsy. Brain magnetic resonance imaging showed an 11 × 9 × 9 mm enhancing homogenous dural-based mass within the posterior part of the left cavernous sinus and posterior clinoid process, displacing the left oculomotor nerve and abutting the internal carotid artery. Treatment with surgery or radiation was not considered as feasible due to the location of the mass and the patient's comorbidities at that time. Given that imaging showed a dural-based mass suggestive of meningioma, and acromegaly recurrence could not be excluded due to IGF-1 being at the upper end of normal, oral octreotide was increased from 40 mg to 80 mg daily, targeting both possible etiologies, with particular rationale based on known somatostatin receptor expression in meningioma. Discussion: Increased octreotide dosage in a patient with acromegaly effectively managed ocular motor palsy and reduced the size of meningioma. Conclusion: Current findings from our case may provide evidence for the potential use of somatostatin analogs in treating acromegaly patients diagnosed with meningiomas, particularly those cases that cannot be surgically removed, to alleviate certain neurological symptoms associated with the condition.