FDA-approved
Hormones & metabolism
Pasireotide
Pasireotide (Signifor) is an FDA-approved somatostatin analog for Cushing's disease and acromegaly. Learn how it works and why it raises blood sugar.
- Reviewed by
- William Maish, MD MBA MPH, Clinical Product Lead
- Published
- October 5, 2026
- Last updated
- October 5, 2026
Key takeaway
Pasireotide (sold as Signifor and Signifor LAR) is a somatostatin analog that binds a broader set of somatostatin receptors than older drugs in its class, which makes it useful in Cushing's disease as well as acromegaly. In a 12-month phase 3 trial in Cushing's disease it reduced urinary free cortisol and normalized it in some patients. It has been FDA-approved in the U.S. since 2012, and its most notable side effect is high blood sugar.
At a glance
| What it is | A multireceptor-targeted somatostatin analog peptide |
| Approved for | Cushing's disease and acromegaly |
| Key fact | In a 12-month phase 3 trial it normalized urinary free cortisol in a subset of Cushing's disease patients |
| Route | Subcutaneous twice daily (Signifor) or monthly intramuscular depot (Signifor LAR) |
| Evidence strength | FDA approved |
What is pasireotide?
Pasireotide, sold as Signifor (twice-daily injection) and Signifor LAR (monthly depot), is a synthetic cyclohexapeptide analog of somatostatin. What sets it apart from octreotide and lanreotide is its broader receptor profile: it binds four of the five somatostatin receptor subtypes, with especially high affinity for subtype 5. That breadth lets it act on tumors that older analogs reach poorly. It was developed under the code SOM230 and approved in the United States in 2012.
How does pasireotide work?
Pasireotide binds multiple somatostatin receptor subtypes, most importantly subtype 5, which is highly expressed on the corticotroph tumors that cause Cushing's disease. Activating those receptors suppresses the tumor's secretion of adrenocorticotropic hormone (ACTH), which in turn lowers cortisol production by the adrenal glands. In acromegaly, the same broad receptor activation suppresses growth hormone and insulin-like growth factor 1.
This receptor breadth is the reason pasireotide is used when other somatostatin analogs are inadequate. In a 12-month phase 3 trial in Cushing's disease, pasireotide reduced and in some patients normalized1 urinary free cortisol, with a greater effect at the higher dose. A notable trade-off is that pasireotide raises blood glucose more than other somatostatin analogs, because its receptor activity reduces insulin secretion.
Is it FDA-approved?
Yes. Pasireotide was approved2 by the FDA in stages:
| Year | Product | Approved for |
| 2012 | Signifor | Cushing's disease when surgery is not an option or has not worked |
| 2014 | Signifor LAR (long-acting) | Acromegaly |
| Later | Signifor LAR (long-acting) | Cushing's disease |
What is pasireotide prescribed for?
Pasireotide is prescribed for Cushing's disease in adults for whom pituitary surgery is not curative or not possible, and for acromegaly inadequately controlled by surgery or other therapy.
What are the side effects?
According to the prescribing information, common side effects include:
- High blood sugar and new-onset diabetes, which can be pronounced
- Diarrhea and nausea
- Gallstones
- Headache, abdominal pain, and fatigue
More serious considerations include:
- Significant hyperglycemia requiring glucose monitoring and treatment
- Slowed heart rate and QT-interval prolongation
- Elevated liver enzymes and low cortisol if suppression is excessive
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Sources: FDA prescribing information for Signifor and Signifor LAR; the phase 3 Cushing's disease trial (Colao et al., New England Journal of Medicine, 2012, DOI: 10.1056/NEJMoa11057431), indexed on PubMed. This document is educational and does not constitute medical advice.