Long-term Treatment of 189 Acromegalic Patients With the Somatostatin Analog Octreotide

Vance, Mary Lee; Harris, Alan G.

doi:10.1001/archinte.1991.00400080073013

Cited by 208 publications

(38 citation statements)

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“…Octreotide is known to suppress serum GH and shrink GH-producing tumors in acromegalic patients [5][6][7], since such pituitary adenomas usually contain a high density of somatostatin receptors with a high affinity for octreotide [20]. Continuous infusion of octreotide showed a better control of GH hypersecretion compared with intermittent injections in previous reports [14,15].…”

Section: Discussionmentioning

confidence: 90%

“…A few previous studies on continuous infusion with a variety of daily doses and periods [16][17][18] have not investigated the shrinkage of pituitary tumor with a small dose for a short duration as in our study. As in a previous report that octreotide induces a shrinkage of the tumor in approximately 50% of GH-producing tumors [6,7], a beneficial result was obtained in tumor shrinkage although we used small doses for a short duration with a continuous infusion pump. Serial analysis of tumor size in three patients showed that tumor shrinkage was evident after the first week of therapy, and considerable tumor shrinkage was seen within the first two weeks even when the dose was as little as 120 µg/day, indicating that octreotide therapy with a continuous infusion pump may be more costand time-effective than intermittent injections.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the treatment with a long-acting somatostatin analog, octreotide, reduces GH hypersecretion in up to 90% of acromegalic patients [5], and induces shrinkage of the tumor size in approximately 50% of GHproducing tumors [6,7]. In fact, octreotide has been used for long-term management of acromegalic patients post-operatively [5].…”

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confidence: 99%

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Preoperative Treatment of Growth Hormone-Producing Pituitary Adenoma with Continuous Subcutaneous Infusion of Octreotide.

et al. 1998

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Abstract. Preoperative therapy with octreotide, a long-acting somatostatin analog, suppresses GH hypersecretion, shrinks GH-producing tumors and leads to an improvement in subsequent surgical remission in acromegalic patients.A continuous infusion of octreotide has demonstrated more persistent suppression of GH secretion than intermittent injections, and only a few studies were reported on the effect of the tumor shrinkage with a continuous infusion of a small dose of octreotide. We therefore investigated the preoperative effects of small doses of octreotide (120-240 jig/day) administered continuously (with a subcutaneous infusion pump) over a short period (2 or 4 weeks) in nine untreated acromegalic patients. Octreotide therapy resulted in suppression of serum GH and IGF-1 concentrations in 8 out of 9 patients and reduction in pituitary tumor size measured by MRI in all patients (by 7.9 to 38.5%). In particular, considerable reduction in tumor size (more than 20%) occurred in 6 of 9 patients. In three patients assessed serially throughout the preoperative period, reduction in tumor size was noted within only one week after the start of octreotide therapy and reduction rate more than 20% was obtained within the first two weeks. In one patient, suprasellar tumor expansion totally disappeared after such therapy. Our results indicate that short-term continuous subcutaneous infusion of a small dose of octreotide results in not only inhibition of GH hypersecretion but also shrinkage of tumor size prior to surgery.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Preoperative Treatment of Growth Hormone-Producing Pituitary Adenoma with Continuous Subcutaneous Infusion of Octreotide.

et al. 1998

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“…Em pacientes com glicemias inicialmente normais foi descrita piora da tolerância à glicose em 20% a 48% (18,43,44) e evolução para DM em 29% (18). Não parece haver correlação entre a dose do octreotide e a mudança no metabolismo da glicose.…”

Section: Discussionunclassified

Avaliação do metabolismo da glicose em pacientes acromegálicos antes e após tratamento com octreotide LAR

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Haute

et al. 2008

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Avaliar o metabolismo da glicose em pacientes acromegálicos antes e após o tratamento com octreotide LAR. Pacientes e métodos: Este foi um estudo longitudinal e prospectivo com 30 pacientes do ambulatório de pesquisa em acromegalia do Serviço de Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Eles foram submetidos à avaliação clínica e laboratorial com dosagens de hormônio do crescimento (GH), fator de crescimento semelhante à insulina tipo I (IGF-I), insulina, pró-insulina, peptídeo C, hemoglobina glicosilada (HbA1c), proteína de ligação do IGF tipo 1 (IGFBP-1) e a um teste oral de tolerância à glicose (TOTG), antes e após seis meses de tratamento com octreotide LAR. Foi aplicado o teste dos postos sinalizados de Wilcoxon e o critério de determinação de significância adotado foi o nível de 5%. Resultados: Encontraram-se 16 pacientes (54%) com tolerância normal à glicose, sete (23%) com intolerância à glicose e sete (23%) com diabetes melito (DM). Doze pacientes completaram os seis meses de tratamento, sendo que houve piora da tolerância à glicose em três e piora do controle glicêmico dos dois pacientes diabéticos. Houve aumento da circunferência abdominal (p = 0,03) e queda do GH (p = 0,04), % IGF-I acima do limite superior do valor de referência (%LSVR) (p = 0,001), insulina (p = 0,019), peptídeo C (p = 0,002) e do modelo de avaliação homeostática (HOMA-IR) (p = 0,039). Conclusões: Nesta série, o tratamento com octreotide LAR acarretou piora da tolerância à glicose em três pacientes não-diabéticos e piora do controle glicêmico em dois diabéticos, apesar da diminuição da resistência insulínica (RI). This was a prospective and longitudinal study involving 30 patients from the acromegaly research outpatient clinic of the Endocrinology unit of the HUCFF/ UFRJ. They underwent clinical and laboratorial evaluations, with measurements of growth hormone (GH), insulin-like growth factor type I (IGF-I), insulin, proinsulin, C peptide, glycosylated hemoglobin (HbA1c), IGF binding protein type 1 (IGFBP-1) and glucose, during oral glucose tolerance test (OGTT), before and after six months of treatment with octreotide LAR. The Wilcoxon signed-rank test was used and values of 5% were considered statistically significant. Results: We found 16 (54%) patients with normal glucose tolerance, 7 (23%) with impaired glucose tolerance and 7 (23%) diabetics. Twelve patients completed the six-month treatment, out of which three

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“…12 In recent years, octreotide proved to be a more potent drug in suppressing GH hypersecretion with 45% of patients reaching normal values. 26,27 Our experience with long-acting somatostatin analog in three patients with continued GH elevation after either adenomectomy alone (one case) or adenomectomy and radiotherapy. (two cases) has been encouraging.…”

Section: Discussionmentioning

confidence: 99%

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

et al. 1995

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A series of 18 consecutive patients with growth hormone-secreting pituitary adenoma treated by surgery were analyzed retrospectively. Apart from an unusually high male-to-female ratio, the demographic data, clinical presentation, and endocrinological findings were similar to those reported by other authors. There were four (22%) microadenomas and 14 (78%) macroadenomas with a large intracranial extension in three patients and gross radiological evidence of invasion of surrounding structures in three others. The mean preoperative basal serum growth hormone level was 48.6 ± 45.4 ng/mL. The tumor resection was carried out via a transsphenoidal route in 15 cases and via frontotemporal craniotomy in the remaining three. One patient died from pulmonary embolism ten days after transcranial tumor resection. The mean postoperative basal growth hormone level was 10.0 ± 10.4 ng/mL. The growth hormone level decreased below 5 ng/mL in six of the 17 survivors (35%) directly after surgery. Nine patients received adjuvant postoperative treatment as follows: dopamine agonist in four, somatostatin analog in one, radiotherapy in one, and a combined drug and radiotherapy in three. The postoperative follow-up period ranged between two and 55 months (mean 28.6). At last follow-up examination, 10 (59%) patients had normalized their basal growth hormone level. Two patients developed postoperative anterior pituitary lobe insufficiency and a third had permanent diabetes insipidus.Acromegaly is a serious medical disorder resulting from the unrestrained secretion of growth hormone (GH). The long-term effects of sustained excess of GH on metabolism and cardiovascular system are deleterious and include diabetes mellitus, arterial hypertension, heart disease, as well as an increased risk of malignancy.1-3 The mortality associated with untreated or partially treated acromegaly is double to threefold the expected rate in healthy subjects matched for age. 4,5 Acromegaly may be caused by a variety of pathological conditions, but GH-secreting pituitary adenomas are by far the most common. 6 The medical literature is rich with reports covering various aspects of this lesion; 4,[7][8][9][10][11][12] however, published data about experiences with this tumor and its management in Saudi Arabia have been lacking entirely. This has prompted us to review all cases of GH-secreting pituitary adenomas which were operated upon in our institution during a period of 10 years and to compare our findings with the relevant data from the literature. Material and MethodsDuring a ten-year period starting in October 1982, 18 consecutive patients with previously untreated growth hormone-secreting pituitary adenoma underwent surgical removal of their tumors at the Neurosurgical Division of King Khalid University Hospital. They constituted 20.5% of all cases of pituitary adenoma treated there during the same period. The diagnosis of a pituitary adenoma was confirmed in all cases with computed tomography (CT) scan and, more recently, magnetic resonance imaging (MRI). A de...

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Long-term Treatment of 189 Acromegalic Patients With the Somatostatin Analog Octreotide

Cited by 208 publications

References 35 publications

Preoperative Treatment of Growth Hormone-Producing Pituitary Adenoma with Continuous Subcutaneous Infusion of Octreotide.

Preoperative Treatment of Growth Hormone-Producing Pituitary Adenoma with Continuous Subcutaneous Infusion of Octreotide.

Avaliação do metabolismo da glicose em pacientes acromegálicos antes e após tratamento com octreotide LAR

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

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