Debulking of pituitary adenomas improves hormonal control of acromegaly by somatostatin analogues

Wass, John

doi:10.1530/eje.1.01896

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…The role of 'debulking' surgery for the effectiveness of postoperative SSA treatment is unclear (8). In our patients, the GH and IGF1 normalization rates were not different from those of the surgery alone group.…”

Section: Ssa Treatment Preceded By Surgerycontrasting

confidence: 51%

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Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register

Petersenn

Buchfelder

Reincke³

et al. 2008

European Journal of Endocrinology

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Background: Data on surgical and medical treatment outcomes in acromegaly mostly originate from specialized centers. We retrospectively analyzed the data on surgery, primary somatostatin analog (SSA) therapy, surgery preceded by SSA, and SSA preceded by surgery in 1485 patients from the German Acromegaly Register. Methods: Two trained nurses visited all centers (NZ42) for data acquisition. Results: Primary surgery: out of 889 patients, 554 yielded analyzable data (microadenomas 22.9%, macroadenomas 77.1%). GH and IGF1 normalized in 54.3 and 67.2%. Partial or total pituitary insufficiency occurred in 28.6% initially and 41.2% post-surgery. Primary SSA (R3 months): out of 329 patients, 145 yielded analyzable data (microadenomas 26.7%, macroadenomas 73.3%). GH and IGF1 normalized in 36.3 and 30.5%, increasing to 40.8 and 41.5% with longer SSA (R360 days) in 54 patients. Pituitary function did not change. SSA (R3 months) prior to surgery: out of 234 patients, 93 yielded analyzable data. Post-surgery GH and IGF1 was normalized in 62.9 and 68.4%. GH improvement was slightly, but significantly better after SSA pretreatment. Surgery followed by SSA: out of 122 patients, 34 yielded analyzable data. GH and IGF1 normalized during SSA in 24.1 and 45.5%. Relative GH decrease was significantly larger compared with primary SSA. Conclusions: Pituitary surgery was more effective to lower GH and IGF1 concentrations than primary SSA. Primary SSA may be an option in selected patients. SSA prior to surgery only marginally improved surgical outcome. Debulking surgery may result in better final outcome in patients with a high GH concentration and a large tumor.

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Section: Ssa Treatment Preceded By Surgerycontrasting

confidence: 51%

“…However, the effect of SSA pretreatment on surgical outcome remains at present unclear (7). On the other hand, 'debulking' surgery has been suggested to improve the efficacy of subsequent SSA treatment (8,9). We analyzed the data of the first 1485 patients from the German Acromegaly Register for these different treatment options.…”

Section: Introductionmentioning

confidence: 99%

Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register

Petersenn

Buchfelder

Reincke³

et al. 2008

European Journal of Endocrinology

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“…Surgical debulking also improves later control by SSA (Wass 2005, Karavitaki et al 2008; not unexpected, as responsiveness to SSA is inversely correlated with pretreatment disease burden; Bhayana et al 2005). Therefore, surgery is indicated also in cases deemed surgically incurable at diagnosis, in order to improve the response to medical treatment (Katznelson 2010).…”

Section: Surgerymentioning

confidence: 94%

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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“…Debulking surgery allows better control of GH levels with somatostatin analogues and radiotherapy, in a recent prospective study using lanreotide as a means of pretreatment both tumour shrinkage preoperatively, and better GH control after surgery were demonstrated [15]. This recent data suggests surgery may be worthwhile even if a cure cannot be realistically expected [16].…”

Section: Acromegalymentioning

confidence: 96%

Transsphenoidal surgery

Joshi

Cudlip

2008

Pituitary

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Transsphenoidal surgery has evolved much over nearly 100 years. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Advances in the understanding of the biology of pituitary tumours, close co-operation between endocrinologists, surgeons and oncologists, and huge advances in imaging and surgical techniques have led to the evolution of the current transsphenoidal operation to the pituitary fossa to the point where a 'cure' is often possible with low complication rates. The indications, contraindications of transsphenoidal surgery will be discussed, together with nature of the surgical approach and how it can be applied to particular pituitary tumours and suprasellar lesions.

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Debulking of pituitary adenomas improves hormonal control of acromegaly by somatostatin analogues

Cited by 13 publications

References 11 publications

Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register

Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Transsphenoidal surgery

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