Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system

Nunes, Vinícius Santana; Correa, Julia Martins Simões; Puga, Maria Eduarda dos Santos; Silva, E. M. K.; Boguszewski, César Luiz

doi:10.1007/s11102-014-0602-9

Cited by 45 publications

(21 citation statements)

References 28 publications

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“…The results of our study should be compared with conclusions of other reports, especially of meta-analyses reported quite recently. According to the first of these, pre-operative SSA increases the chance of biochemical control of acromegaly 3 months after transsphenoidal surgery in patients harbouring GH-secreting macroadenomas [13]. Another such meta-analysis reported on the safety of pre-operative SSA in acromegaly, and the favourable impact of pre-operative SSA on surgical results was restricted to the short-term cure rate in macroadenomas and invasive macroadenomas [14].…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly

Bolanowski

Zgliczyński

Sowiński

et al. 2020

Endokrynologia Polska

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Introduction: The aim of this study was to assess the therapeutic effect and the safety of pre-surgical treatment with long-acting octreotide in patients with acromegaly. Material and methods: This project was conducted in 25 centres across Poland as a non-interventional, multicentre, observational study in patients with acromegaly, in which long-acting octreotide (Sandostatin ® LAR ®) was administered before surgery. They were 148 patients included into the study: 88 females and 60 males aged 18-86 years (51.3 ± 13.4). Results: Eighty patients completed the study (underwent tumour surgery). The CRF included: baseline visit, four follow-up visits every three months before surgery, and two follow-up visits every three months after surgery. Sandostatin ® LAR ® was administered every four weeks. The efficacy measures were as follows: change of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, number of patients fulfilling criteria of cure, and change of adenoma (micro-and macroadenomas) size during the treatment. Normalisation of GH and IGF-1 concentrations were obtained in 42.4 and 49.1% of patients at the end of medical therapy, respectively. Normalisation of GH and IGF-1 concentrations were obtained in 77.9 and 83.8% of patients after surgery, respectively. Reduction of microadenoma size was documented in 58.8% of patients, and in 70% of patients with macroadenomas at the end of medical therapy. In 74.0% of patients no pituitary tumour was shown on MRI after surgery. Conclusion: In conclusion, we have shown good surgical outcome in patients with acromegaly after pre-treatment with somatostatin analogue, and good tolerance and safety of the therapy, supporting the national recommendation for pre-surgical treatment with longacting somatostatin analogues in acromegaly patients.

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Section: Discussionmentioning

confidence: 99%

“…Several studies document the advantageous effects of pre-surgical SSA administration in acromegaly [7][8][9], but others do not support this attitude [10][11][12]. Recently performed meta-analyses deliver conflicting data [13][14][15][16]. Some guidelines advise [5] presurgical SSA application, whereas other do not [3,4].…”

Section: Methodsmentioning

confidence: 99%

Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly

Bolanowski

Zgliczyński

Sowiński

et al. 2020

Endokrynologia Polska

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“…Given these observations, the use of preoperative SRIF analogs to improve surgical outcomes has been debated. Although studies have shown that postoperative biochemical control is in fact improved by presurgical SRIF analog treatment ( Carlsen et al, 2008 ; Nunes et al, 2015 ), the overall evidence is dampened by the short follow-up duration and insufficient prospective evidence.…”

Section: Somatotropin-release Inhibitory Factor Analogs In Currentmentioning

confidence: 99%

International Union of Basic and Clinical Pharmacology. CV. Somatostatin Receptors: Structure, Function, Ligands, and New Nomenclature

et al. 2018

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Somatostatin, also known as somatotropin-release inhibitory factor, is a cyclopeptide that exerts potent inhibitory actions on hormone secretion and neuronal excitability. Its physiologic functions are mediated by five G protein–coupled receptors (GPCRs) called somatostatin receptor (SST)1–5. These five receptors share common structural features and signaling mechanisms but differ in their cellular and subcellular localization and mode of regulation. SST2 and SST5 receptors have evolved as primary targets for pharmacological treatment of pituitary adenomas and neuroendocrine tumors. In addition, SST2 is a prototypical GPCR for the development of peptide-based radiopharmaceuticals for diagnostic and therapeutic interventions. This review article summarizes findings published in the last 25 years on the physiology, pharmacology, and clinical applications related to SSTs. We also discuss potential future developments and propose a new nomenclature.

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“…Immediate results of surgery are significantly better in pretreated cases (Carlsen et al 2008, Shen et al 2010, but the long-term results are conflicting: some authors report no difference (Shen et al 2010) while others report a slightly higher cure rate in the pretreated group at 5 years follow-up (41% vs 27%) (Fougner et al 2014). In a recent meta-analysis, the chance of surgical remission (GH nadir after OGTT !1 mg/l and normal age-matched IGF1) was overall higher in pretreated patients (Nunes et al 2015). However, the extent and quality of the currently available evidence supporting the routine use of presurgical SSA are low, so it is not recommended as a routine approach (Katznelson et al 2014).…”

Section: Surgerymentioning

confidence: 99%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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Acromegaly (ACM) is a chronic, progressive disorder caused by the persistent hypersecretion of GH, in the vast majority of cases secreted by a pituitary adenoma. The consequent increase in IGF1 (a GH-induced liver protein) is responsible for most clinical features and for the systemic complications associated with increased mortality. The clinical diagnosis, based on symptoms related to GH excess or the presence of a pituitary mass, is often delayed many years because of the slow progression of the disease. Initial testing relies on measuring the serum IGF1 concentration. The oral glucose tolerance test with concomitant GH measurement is the gold-standard diagnostic test. The therapeutic options for ACM are surgery, medical treatment, and radiotherapy (RT). The outcome of surgery is very good for microadenomas (80-90% cure rate), but at least half of the macroadenomas (most frequently encountered in ACM patients) are not cured surgically. Somatostatin analogs are mainly indicated after surgical failure. Currently their routine use as primary therapy is not recommended. Dopamine agonists are useful in a minority of cases. Pegvisomant is indicated for patients refractory to surgery and other medical treatments. RT is employed sparingly, in cases of persistent disease activity despite other treatments, due to its long-term side effects. With complex, combined treatment, at least three-quarters of the cases are controlled according to current criteria. With proper control of the disease, the specific complications are partially improved and the mortality rate is close to that of the background population.

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Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system

Abstract: Pre-SA increases the chance of biochemical control of acromegaly 3 months after TSS in patients harboring GH-secreting pituitary macroadenomas.

Cited by 45 publications

References 28 publications

Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly

Therapeutic effect of presurgical treatment with longacting octreotide (Sandostatin® LAR®) in patients with acromegaly

International Union of Basic and Clinical Pharmacology. CV. Somatostatin Receptors: Structure, Function, Ligands, and New Nomenclature

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

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