The effect of minisomatostatin on anomalous growth hormone responses in acromegaly

Abstract

Twelve patients with active acromegaly were treated with the long-acting somatostatin analogue SMS 201-995 at a dose of 50 \ g=m\ g sc twice daily in the first 2 weeks of treatment and 100 \ g=m\ g twice daily thereafter. Four hours after the first injection of SMS, GH levels became normal in 8 of the 12 patients. The GH response after hpGRF administration was strongly suppressed by SMS. Paradoxical GH responses to TRH disappeared in 6 out of 7 patients during SMS. Paradoxical GH responses to LHR, however, persisted in 4 out of 4 patients. Paradoxical responses of GH after glucose loading disappeared in 2 out of 2 patients. We conclude that SMS normalizes most anomalous growth hormone kinetics in acromegaly. This drug offers a new tool in the treatment of this disease.

Preoperative Treatment of Acromegaly with Long-Acting Somatostatin Analog SMS 201-995: Shrinkage of Invasive Pituitary Macroadenomas and Improved Surgical Remission Rate*

“…This drug inhibits spontaneous (8)(9)(10)(11)(12) and GHRH or TRH-stimulated (15,26) GH secretion in patients with acromegaly due to pituitary tumors or somatotroph hyperplasia secondary to ectopic GHRH secretion (27,28). Moreover, shrinkage of pituitary tumors (8)(9)(10)(11)(12) and of hyperplasia (27,28) has been reported in some patients treated with this drug.…”

Octreotide Treatment Results in the Inhibition of GH Gene Expression in the Adenoma of the Patients with Acromegaly.

“…The treatment brought about an effective decrease in the serum GH and somatomedin-C levels [6][7][8][9][10]12]. At the surgery, the adenomas were soft and easily removed.…”

“…[5]]. When it was administered by repeated or continuous subcutaneous injection, marked improvement of clinical symptoms [6][7][8], normalization of circulating GH and somatomedin-C levels [9], and disappearance of paradoxical responses of GH [10] were reported. Shrinking of the adenomas was also demonstrated by magnetic resonance imaging (MRI) [11,12].…”

Six year remission of ACTH-dependent Cushing's syndrome using bromocriptine

“…Most studies have concentrated on the acute response to bromocriptine therapy. The largest series is that of Pieters et al (1982), who found a statistically significant fall in plasma cortisol over a four hour period in three of 17 patients following a 5mg test dose. Three others had falls which were not significant.…”

“…Since reports on the efficacy ofbromocriptine at any stage of Cushing's disease are relatively rare, and mostly of a short term nature (Lamberts & Birkenhager, 1976;Lamberts et al, 1977;Kennedy et al, 1978;Ambrosi et al, 1979;Lamberts et al, 1980;Pieters et al, 1982;Lamberts et al, 1982;Kapcala & Jackson, 1983), it is of interest to report in detail a prolonged remission (six years) of Cushing's disease in a patient who concurrently received external pituitary irradiation. Various possibilities to account for this remission were considered.…”