Octreotide LAR <i>vs.</i> surgery in newly diagnosed patients with acromegaly: a randomized, open‐label, multicentre study

Colao, Annamaria; Cappabianca, Paolo; Caron, Philippe; Menis, Ernesto De; Farrall, Andrew; Gadelha, Mônica R.; Hmissi, Abdel; Rees, Aled; Reincke, Martín; Safari, Mitra; T’Sjoen, Guy; Bouterfa, Hakim; Cuneo, Ross C.

doi:10.1111/j.1365-2265.2008.03441.x

Cited by 100 publications

(67 citation statements)

References 40 publications

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“…A significant proportion of patients with large macroadenomas extending outside the sella will experience persistently elevated GH levels postoperatively, often requiring subsequent medical therapy and/or radiosurgery to gain satisfactory biochemical control. 5,18 Some authors have argued primary medical therapy may be used for patients with GH-secreting macroadenomas with extrasellar extension, which makes complete surgical resection unfeasible. 5,18 However, other authors have asserted that initial operative debulking of these macroadenomas may increase the proportion of patients that subsequently attain hormonal control with adjunctive therapy, particularly if more than 75% of the initial tumor volume is resected.…”

Section: Discussionmentioning

confidence: 99%

“…5,18 Some authors have argued primary medical therapy may be used for patients with GH-secreting macroadenomas with extrasellar extension, which makes complete surgical resection unfeasible. 5,18 However, other authors have asserted that initial operative debulking of these macroadenomas may increase the proportion of patients that subsequently attain hormonal control with adjunctive therapy, particularly if more than 75% of the initial tumor volume is resected. 17,35,48,54 To demonstrate safety and efficacy an attempt was made to carefully evaluate and report the biochemical results of endoscopic resection of GH-secreting adenomas in the current series.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Campbell¹,

Kenning

Andrews³

et al. 2010

FOC

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Object Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)–secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. Methods A retrospective review of a prospectively maintained database was performed. The authors reviewed cases in which an endoscopic resection of GH-secreting pituitary adenomas was performed. The cohort consisted of 26 patients who had been followed for 3–60 months (mean 24.5 months). The thresholds of an age-appropriate, normalized insulin-like growth factor–I concentration, a nadir GH level after oral glucose load of less than 1.0 μg/l, and a random GH value of less than 2.5 μg/l were required to establish biochemical cure postoperatively. Results Overall, in 57.7% of patients undergoing a purely endoscopic transsphenoidal pituitary adenectomy for acromegaly, an endocrinological cure was achieved. The mean clinical follow-up duration was 24.5 months. In patients with microadenomas (4 cases) the cure rate was 75%, whereas in patients harboring macroadenomas (22 cases) the cure rate was 54.5%. Cavernous sinus invasion (Knosp Grades 3 and 4) was associated with a significantly lower remission rate (p = 0.0068). Hardy Grade 3 and 4 tumors were also less likely to achieve biochemical cure (p = 0.013). The overall complication rate was 11.5% including 2 incidents of transient diabetes insipidus and 1 postoperative CSF leak, which were treated nonoperatively. Conclusions A purely endoscopic transsphenoidal approach to GH-secreting pituitary adenomas leads to similar outcome for noninvasive macroadenomas compared with traditional microsurgical techniques. Furthermore, this approach may often provide maximal visualization of the tumor, the pituitary gland, and the surrounding neurovascular structures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Campbell¹,

Kenning

Andrews³

et al. 2010

FOC

View full text Add to dashboard Cite

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“…In the prospective multicenter studies with both octreotide LAR and lanreotide autogel, biochemical control of acromegaly was obtained in about 30 % of the patients, and tumor shrinkage was observed in *75 % of the patients [10,11]. SSAs have also been compared with surgery as the primary treatment for acromegaly in a randomized-controlled trial including 101 patients; this trial showed that the two interventions do not differ in terms of biochemical and tumor control outcomes [14]. In all of these prospective trials with SSA, the drugs showed good safety profiles with no serious adverse events.…”

Section: Cabergoline As a Monotherapymentioning

confidence: 99%

Cabergoline treatment in acromegaly: cons

Kasuki

Neto

2014

Endocrine

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Many options are available for the treatment of acromegaly, including surgery, radiotherapy, and medical treatment. Cabergoline (CAB), a dopamine agonist with high affinity for dopamine receptor type 2, has been used both in monotherapy and in conjunction with somatostatin analogs (SSAs). Although it is administered orally and has a relatively lower-cost in comparison with SSAs, few studies have demonstrated its usefulness, there is a lack of randomized-controlled trials and other drugs (SSAs and pegvisomant) with more data in the literature are available; these issues are the main drawbacks of adopting CAB for the treatment of acromegaly.

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“…Somatostatin analogues are considered the first option of medical treatment in the majority of patients, but prospective randomized studies show control rates of 20-40% for patients with first-generation SA (4,(7)(8)(9)(10)(11). Pasireotide LAR, a next-generation SA (not yet approved for acromegaly treatment in Brazil), allows disease control in a higher percentage of patients and is effective in approximately 15% of those patients not controlled by first-generation SA with the dose of 40 mg and in 20% of the patients with the dose of 60 mg (12,13).…”

Section: Introductionmentioning

confidence: 99%

Experience with pegvisomant treatment in acromegaly in a single Brazilian tertiary reference center: efficacy, safety and predictors of response

Kasuki

Machado

Ogino

et al. 2016

Arch. Endocrinol. Metab.

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Objective: To describe the safety and efficacy of pegvisomant therapy and the predictors of treatment response in acromegaly patients at a single tertiary reference center in Brazil. Materials and methods: We retrospectively reviewed the clinical, hormonal and radiological data of acromegaly patients treated with pegvisomant in our center. We also evaluated the presence of the d3 isoform of the growth hormone receptor (d3GHR). Results: Twenty-seven patients were included (17 women). Pegvisomant was used in combination with octreotide LAR in 20 patients (74%), in combination with cabergoline in one (4%) and as monotherapy in six (22%). IGF-I normalization was achieved in 23 patients (85%). Mild and transitory elevation of liver enzymes was observed in two patients (7.4%), tumor growth in one (3.4%) and lipodystrophy in two (7.4%). One patient stopped the drug due to headaches. The GHR isoforms were evaluated in 14 patients, and the presence of at least one d3GHR allele was observed in 43% of them, but it was not a predictor of treatment response. Only pretreatment IGF-I level was a predictor of treatment response. Conclusion: Pegvisomant treatment was highly effective and safe in our series of Brazilian patients. A better chance of disease control can be expected in those with lower pre-pegvisomant IGF-I levels. Arch Endocrinol Metab. 2016;60(5):479-85

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Octreotide LAR vs. surgery in newly diagnosed patients with acromegaly: a randomized, open‐label, multicentre study

Cited by 100 publications

References 40 publications

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

Cabergoline treatment in acromegaly: cons

Experience with pegvisomant treatment in acromegaly in a single Brazilian tertiary reference center: efficacy, safety and predictors of response

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