Decision Analysis of Treatment Options in Acromegaly

Pathophysiology and clinical aspects of the ectopic GH‐releasing hormone syndrome

“…Logically, surgery was ineffective in patients with metastatic spread of the GHRHsecreting tumour (von Werder et al, , 1987Lefebvre et al, 1995;Genka et al, 1995), even though a slight reduction in GHRH and GH level occurred in our two cases. Recurrence of acromegaly was described in two patients who had relapse of the primary GHRH-secreting tumour within 3 years of operation (Sassolas et al, 1983;Scheithauer et al, 1984).…”

“…Interestingly recovery of normal pituitary morphology was slowly progressive in one patient (Barth et al, 1991) the first CT scan 3 months after surgery showed a decrease in the vertical height of the pituitary lesion, whereas a repeated CT scan at 10 months was entirely normal. Logically, surgery was ineffective in patients with metastatic spread of the GHRHsecreting tumour (von Werder et al, , 1987Lefebvre et al, 1995;Genka et al, 1995), even though a slight reduction in GHRH and GH level occurred in our two cases. Recurrence of acromegaly was described in two patients who had relapse of the primary GHRH-secreting tumour within 3 years of operation (Sassolas et al, 1983;Scheithauer et al, 1984).…”

“…Primary and metastatic lesions did not regress under chronic octreotide therapy in most patients, except our two cases (von Werder et al, , 1987 and one other patient who showed significant shrinkage and then disappearance of metastatic lesions when the dose of the drug was increased while plasma GHRH level fell considerably (Barkan et al, 1986). The patient described by Lefebvre et al (1995) experienced growth of new intramedullary and vertebral metastases after 19 months of octreotide therapy while serum GH and IGF-I were maintained within the normal range, suggesting that escape from the antiproliferative effect of the drug may occur in the long term and that tumour growth may be dissociated from inhibition of GH secretion.…”

“…Octreotride therapy was usually given to patients with disseminated GHRH-secreting tumours that could not be removed completely by surgery. Normalization of GH and IGF-I levels was achieved in most of the treated patients (Ch'ng et al, 1985;von Werder et al, 1986von Werder et al, , 1987Barkan et al, 1988;Melmed et al, 1988;Bertherat et al, 1994;Lefebvre et al, 1995), whereas slight (Moller et al, 1989; or no improvement (Southgate et al, 1988;Ezzat et al, 1994) was reported in the others. An undetectable plasma GHRH level was never achieved in any patient, although significant decreases in the circulating peptide were reported (Fig.…”