Effect of treatment with octreotide on the morphology of growth hormone—secreting pituitary adenomas: Study of 24 cases

Beckers, Albert; Kovács, Kálmán; Horváth, Éva; Abs, Roger; Reznik, M; Stevenaert, Achille

doi:10.1007/bf02915452

Cited by 12 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The morphological changes in adenomatous tissue, namely widening of perivascular spaces and mild to moderate perivascular fibrosis noticeable by pathol-ogy, can be taken into account as a partial explanation(22). In addition, in one patient with an ACTH-secreting adenoma that was surgically proven and with negative CT and MR imaging, the scintigraphy showed a significant uptake of [ mTc](V)DMSA in the pituitary region, confirming the results of the inferior petrosal sinus sampling.…”

supporting

confidence: 65%

Technetium-99m pentavalent dimercaptosuccinic acid imaging in patients with pituitary adenomas

Lastoria¹,

Colao

Vergara

et al. 1995

European Journal of Endocrinology

View full text Add to dashboard Cite

We studied the tumor-seeking agent technetium-99m-labeled pentavalent dimercaptosuccinic acid ([99mTc](V)DMSA) to visualize 21 growth hormone (GH)-, nine prolactin (PRL)-, two mixed GH/PRL-, six adrenocorticotrophin (ACTH)-secreting and 15 clinically non-functioning pituitary adenomas, three craniopharyngiomas and one dysgerminoma of the sella. All non-adenomas and 31 out of 53 adenomas were studied before treatment: 22 after surgery and/or radiotherapy. Eight cases of acromegaly were studied before and after chronic treatment with octreotide, whereas three cases of acromegaly, one of prolactinoma and two of non-functioning adenoma were imaged before and after adenomectomy. As a control group, 27 patients without any clinical evidence of pituitary adenoma were studied: 10 of them were operated on previously and treated with iodine-131 for metastatic thyroid carcinoma, 10 had brain tumors and the remaining seven patients had functional pituitary hypersecretion (four Klinefelter's syndrome, two primary hypothyroidism and one Addison's disease). The scintigraphy was repeated after testosterone in Klinefelter's syndrome, L-thyroxine in primary hypothyroidism and cortisone administration in Addison's disease. Seventeen GH-secreting (81%), seven PRL-secreting (78%), three ACTH-secreting (50%), 15 non-functioning (100%) and one (50%) mixed adenoma significantly concentrated [99mTc](V)DMSA, showing elevated tumor-to-background (T/B) ratios. The T/B ratios were similar in untreated and surgically treated adenomas (11.2 +/- 5.6 vs 11.8 +/- 6.2). Radiotherapy significantly lowered the [99mTc](V)DMSA uptake to 5.1 +/- 2.8 (p < 0.1 vs untreated patients). Non-adenomatous lesions of the sella turcica did not concentrate [99mTc](V)DMSA in the pituitary as well as brain tumors and 8 out of 10 metastatic thyroid cancers. The treatment with octreotide normalized GH and insulin-like growth factor I levels and reduced [99mTc](V)DMSA from 15.7 +/- 4.8 to 13.5 +/- 3.9 (p < 0.05). Conversely, adequate substitutive therapy completely inhibited the uptake of the radiotracer in Klinefelter's syndrome, in primary hypothyroidism and in Addison's disease. The [99mTc](V)DMSA scintigraphy showed an overall sensitivity of 81% (43/53) in detecting pituitary adenomas, which was increased to 95% for lesions greater than 10 mm in size. High-quality images with minimal total body radiation were obtained, enabling a good in vivo characterization of viable adenomatous tissue as well as an accurate monitoring of the effects of different therapeutic regimens.

show abstract

supporting

confidence: 65%

Technetium-99m pentavalent dimercaptosuccinic acid imaging in patients with pituitary adenomas

Lastoria¹,

Colao

Vergara

et al. 1995

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Several mechanisms have been proposed for the observed reversible tumor shrinkage; however, the exact cellular mechanism remains unclear. 13,32,79 Primary therapy, as expected, has more impressive shrinkage results. 76 In a prospective study in 99 patients with acromegaly, 75.5% experienced ≥ 25% tumor shrinkage after 12 months, while a significant increase in tumor mass occurred in only 2.1% of the patients.…”

Section: Tumor Shrinkagesupporting

confidence: 67%

Acromegaly: a review of current medical therapy and new drugs on the horizon

Fleseriu

Delashaw²,

Cook

2010

FOC

View full text Add to dashboard Cite

Acromegaly is a disease that results from a growth hormone (GH)–secreting pituitary tumor. Clinically, the disease is characterized by excessive skeletal growth, soft tissue enlargement with disfigurement, and increased risk of cardiovascular death. The goals of treatment are the removal or reduction of the tumor mass via surgery and normalization of GH secretion. Another treatment goal is the preservation of normal pituitary function if possible. Transsphenoidal surgery by an experienced neurosurgeon is usually the first line of therapy, especially for small tumors. Surgeon expertise is crucial for outcome, with dedicated pituitary surgeons having better results. However, overall cure rates remain low because patients with these tumors usually present at an incurable stage. Therefore, medical therapy to control excess GH secretion plays a significant role in a large proportion of patients with acromegaly who are not cured by surgery or other forms of therapy, such as radiotherapy, and/or are awaiting the effects of radiotherapy. If surgery is not curative, lifelong monitoring and the control of excess GH is usually necessary by a care team experienced in handling this chronic disease. In the past decade major progress has occurred in the development of highly specific and selective pharmacological agents that have greatly facilitated more aggressive management of active acromegaly. Treatment approach should be individualized and take into consideration a patient's tumor size and location, symptoms, comorbid conditions, and preferences. Because a surgical cure can be difficult to achieve, all patients, even those with what seems to be a clinically and biochemically inactive disease, should undergo long-term biochemical testing and pituitary MR imaging.

show abstract

“…complex pattern of morphological alterations within the tumor that include decreases in secretory granule number and capacity and fibrosis (12,13).…”

mentioning

confidence: 99%

Does Preoperative Somatostatin Analog Treatment Improve Surgical Cure Rates in Acromegaly? A New Look at an Old Question

Beckers

2008

The Journal of Clinical Endocrinology &Amp; Metabolism

Self Cite

View full text Add to dashboard Cite

A cromegaly is caused in most cases by chronic GH hypersecretion from a pituitary adenoma. Typically, acromegaly has an insidious onset, with patients often suffering from unrecognized signs and symptoms for up to a decade before diagnosis (1). Apart from the characteristic physical changes to the face and extremities, patients with acromegaly are at increased risk for cardiac disease and colorectal cancer (2-4). Retrospective cohort studies show that chronic GH hypersecretion increases mortality, which can be returned to normal with effective control of GH and IGF-I (5, 6). Surgery, usually via the transsphenoidal route, is first-line therapy for acromegaly in suitable and willing patients. The surgical cure rate is 70 -85% for noninvasive microadenomas and enclosed (noninvasive) macroadenomas, and for large macroadenomas and invasive tumors, the cure rate is lower (20 -50%); the overall cure rate is in the region of 55-65% (7). The expertise of the surgeon is a crucial element in the outcome of acromegaly, with dedicated pituitary neurosurgeons having better results (8).Somatostatin analogs (SSAs) are the main medical treatment for acromegaly, and some centers have more than 20-yr experience with these compounds. In general, SSAs are used as an adjuvant therapy in patients whose symptoms and hormone abnormalities are not completely controlled by surgery. Primary therapy with a SSA is increasing in popularity, particularly among elderly or infirm subjects, or among those unwilling to undergo surgery. Adjuvant SSA therapy normalizes GH and IGF-I in 49 -56% and 48 -66% of patients, respectively (9). Primary SSA treatment controls GH and IGF-I in approximately 50 and 60% of patients, respectively. SSAs are also associated with tumor shrinkage in acromegaly, with approximately 37% of patients showing some decrease in tumor size during primary medical therapy (10), and 21% of those receiving adjuvant SSA treatment (11). This tumor shrinkage does not appear to be due to tumoricidal or strong pro-apoptotic effects but, rather, to a

show abstract

Effect of treatment with octreotide on the morphology of growth hormone—secreting pituitary adenomas: Study of 24 cases

Cited by 12 publications

References 18 publications

Technetium-99m pentavalent dimercaptosuccinic acid imaging in patients with pituitary adenomas

Technetium-99m pentavalent dimercaptosuccinic acid imaging in patients with pituitary adenomas

Acromegaly: a review of current medical therapy and new drugs on the horizon

Does Preoperative Somatostatin Analog Treatment Improve Surgical Cure Rates in Acromegaly? A New Look at an Old Question

Contact Info

Product

Resources

About