Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study

Plöckinger, Ursula; Quabbe, H.-J.

doi:10.1007/s00701-005-0511-9

Cited by 57 publications

(30 citation statements)

References 36 publications

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“…They were randomly divided into two groups. The experimental group comprised roadenomas and boosts the final cure rate is unclear [11][12][13][14][15]. In assessing the historical experience, analysis is challenging because most studies are retrospective.…”

Section: Patients (Table 2)mentioning

confidence: 99%

“…In assessing the historical experience, analysis is challenging because most studies are retrospective. The lack of direct comparisons, reliance on single GH values, a large range of octreotide doses utilized, and relatively small numbers of patients, are among the confounding factors [10,13,16]. Besides, the different proportion of patients with different tumor characters (size and invasiveness) makes these conclusions less instructive (Table 1).…”

Section: Patients (Table 2)mentioning

confidence: 99%

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Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study

et al. 2010

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The recenT paradigm for managing acromegaly includes microsurgery or endoscopic surgery (transsphenoidal surgery or craniotomy), pharmacological therapy (somatostatin analogue, growth hormonereceptor antagonist, dopamine receptor agonists) and radiosurgery which reverse excessive growth hormone (GH) secretion, and shrink or ablate tumors without compromising normal pituitary function. Maximal control of GH level, reduction of systemic complications and mortality, control of tumor growth, preservation of pituitary function, and extension of life expectancy are the aims of disease management. But these Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study Abstract. Therapeutic effects of presurgical long-acting octreotide treatment on tumor shrinkage, and short-and long-term postoperative GH and IGF-1 levels of acromegaly patients with invasive pituitary macroadenomas were investigated prospectively in Huashan Hospital, Shanghai, China. Thirty-nine untreated acromegaly patients, all with invasive pituitary macroadenomas, were randomly divided into two groups: experimental group (n=19), and control group (n=20). Patients in the experimental group received a three-month course of long-acting octreotide treatment before transsphenoidal surgery; the control group underwent surgery directly. Tumor shrinkage after drug treatment and short-and long-term postoperative GH and IGF-1 levels were analyzed in the two groups. Long-acting octreotide treatment reduced tumor size from 7893 ± 6450 to 4794 ± 4682 mm 3 . Mean shrinkage rate was 37.4 ± 30.9%. GH and IGF-1 levels of the experimental group were lower than the control group at 3 months, 6 months after surgery, and after long-term follow-up. Remission rate (both GH and IGF-1 normal) of the experimental group was higher at 3 and 6 months follow-up, but exhibited no advantage in longterm follow-up. In the experimental group, the total resection rate was higher in patients whose Hardy-Knosp grading decreased to ≤ 2 than those whose Hardy-Knosp grading is still ≥ 3 after drug pretreatment. In conclusion, presurgical long-acting octreotide treatment effectively reduces tumor size and invasion, which helps enhance early remission rates of invasive macroadenomas by transsphenoidal surgery, but does not appear to improve the long-term cure rate.

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Section: Patients (Table 2)mentioning

confidence: 99%

Section: Patients (Table 2)mentioning

confidence: 99%

Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study

et al. 2010

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“…Tumor sizes were calculated by the Di Chiro and Nelson formula: volume = height × length × width × π/6 [22]. When T2-weighted images were available, the T2 intensity of the solid portion was visually compared with the cerebral grey and white matter in the adjacent temporal lobe.…”

Section: Magnetic Resonance Imaging (Mri) Studiesmentioning

confidence: 99%

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

Wang

Shen

et al. 2016

Endocr J

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“…Other studies, however, showed no benefit. 25,40 Further investigation is needed to define the role of presurgical pharmacological treatment in acromegaly.…”

Section: Primary or Secondary Pharmacological Therapymentioning

confidence: 99%

Pharmacological management of acromegaly: a current perspective

Manjila

Khan

et al. 2010

FOC

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Acromegaly is a chronic disorder of enhanced growth hormone (GH) secretion and elevated insulin-like growth factor–I (IGF-I) levels, the most frequent cause of which is a pituitary adenoma. Persistently elevated GH and IGF-I levels lead to substantial morbidity and mortality. Treatment goals include complete removal of the tumor causing the disease, symptomatic relief, reduction of multisystem complications, and control of local mass effect. While transsphenoidal tumor resection is considered first-line treatment of patients in whom a surgical cure can be expected, pharmacological therapy is playing an increased role in the armamentarium against acromegaly in patients unsuitable for or refusing surgery, after failure of surgical treatment (inadequate resection, cavernous sinus invasion, or transcapsular intraarachnoid invasion), or in select cases as primary treatment. Three broad drug classes are available for the treatment of acromegaly: somatostatin analogs, dopamine agonists, and GH receptor antagonists. Somatostatin analogs are considered as the first-line pharmacological treatment of acromegaly, although efficacy varies among the different formulations. Octreotide long-acting release (LAR) appears to be more efficacious than lanreotide sustained release (SR). Lanreotide Autogel (ATG) has been shown to result in similar biological control as octreotide LAR, and there may be a benefit in switching from one to the other in some cases of treatment failure. The novel multireceptor somatostatin analog pasireotide, currently in Phase II clinical trials, also shows promise in the treatment of acromegaly. Dopamine agonists have been the earliest and most widely used agents in the treatment of acromegaly but have been found to be less effective than somatostatin analogs. In this class of drugs, cabergoline has shown greater efficacy and tolerability than bromocriptine. Dopamine agonists have the advantage of oral administration, resulting in increased use in select patient groups. Selective GH receptor antagonists, such as pegvisomant, act by blocking the effects of GH, resulting in decreased IGF-I production despite persistent elevation of GH serum levels. Thus far, tumor growth has not been a concern during pegvisomant therapy. However, combination treatment with somatostatin analogs may counteract these effects. The authors discuss the latest guidelines for biochemical cure and highlight the efficacy of combination therapy. In addition, the effects of pharmacological presurgical treatment on surgical outcome are explored.

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Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study

Abstract: Presurgical octreotide treatment has no significant short- or long-term beneficial effect on GH concentration or pituitary function.

Cited by 57 publications

References 36 publications

Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study

Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study

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

Pharmacological management of acromegaly: a current perspective

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