Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial

Abstract

Objective: Randomised studies have demonstrated a beneficial effect of pre-surgical treatment with somatostatin analogues (SSA) in acromegaly when evaluated early postoperatively. The objective of this study was to evaluate the long-term surgical cure rates. Methods: Newly diagnosed patients were randomised to direct surgery (nZ30) or 6-month pretreatment with octreotide LAR (nZ32). The patients were evaluated 1 and 5 years postoperatively. Cure was defined as normal IGF1 levels and by normal IGF1 level combined with nadir GH !2 mU/l in an oral glucose tolerance test, all without additional post-operative treatment. A meta-analysis using the other published randomised study with long-term analyses on preoperative SSA treatment was performed. Results: The proportion of patients receiving post-operative acromegaly treatment was equal in the two groups. When using the combined criteria for cure, 10/26 (38%) macroadenomas were cured in the pretreatment group compared with 6/25 (24%) in the direct surgery group 1 year postoperatively (PZ0.27), and 9/22 (41%) vs 6/22 (27%) macroadenomas, respectively, 5 years postoperatively (PZ0.34). In the meta-analysis, 16/45 (36%) macroadenomas were cured using combined criteria in the pretreatment group vs 8/45 (18%) in the direct surgery group after 6-12 months (PZ0.06), and 15/41 (37%) vs 8/42 (19%), respectively, in the long-term (PZ0.08). Conclusion: This study does not prove a beneficial effect of SSA pre-surgical treatment, but in the meta-analysis a trend towards significance can be claimed. A potential favourable, clinically relevant response cannot be excluded.

Polymorphism of Cytochrome P450, Superfamily19, Polypeptide 1 Gene and Related to Aromatase Enzyme Activity in Acromegaly Iraqi Patients

“…Acromegaly is an uncommon hormonal condition that develops most commonly from benign somatotroph pituitary adenomas; the clinical indications connected with acromegaly are a result of the chronic overproduction of growth hormone (GH) and insulin-like growth factor 1 [1,2]. Systemic complications usually connected with the chronic hypersecretion of GH and insulin-like growth factor 1 (IGF-1) include acromegaly, soft tissue changes, and arthralgia, and comorbidities include type 2 diabetes, hypertension, carpal tunnel syndrome, and sleep apnea [3].…”

Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future

“…Long-term observational data (1 and 5 years post-operatively) for these patients, however, revealed no significant impact of pre-operative treatment on macroadenomas (Fougner et al 2014). Remission rates (IGF-1 ≤ age-adjusted ULN) of 49 and 18% were found in a single-centre study of 98 patients with newly diagnosed macroadenomas who received 4-month pre-treatment with lanreotide Autogel before surgery or surgery without pre-treatment, respectively ).…”

The value of an acute octreotide suppression test in predicting short-term efficacy of somatostatin analogues in acromegaly

“…The value of primary therapy (pre-surgical administration) is controversial, but a recent meta-analysis by Fougner et al suggested a trend favoring preoperative SSA treatment [16]. However, one third of patients responded poorly or was resistant to SSA [25].…”

“…Since then, the octreotide suppression test (OST) has become routine practice in many endocrine centers [12], but the value of the OST in predicting long-term response to SSA therapy is still controversial [12][13][14][15]. Moreover, shortterm pre-surgical treatment with SSA in macroadenomas has been supported by a few studies and a recent meta-analysis [16], but it is unclear whether or not the OST can predict the efficacy of SSA after a relatively shorter period of usage, e.g. 3 months.…”