Effect of 4 weeks of octreotide treatment on prolactin, thyroid stimulating hormone and thyroid hormones in acromegalic patients. A double blind placebo-controlled cross-over study

Andersen, Marianne; Hansen, Torben Bæk; Bollerslev, Jens; Bjerre, Per; Hagen, Claus

doi:10.1007/bf03349830

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…It has been suggested that mammosomatotroph cells comprise a significant portion of the cell population in pituitary adenomas from acromegalic patients (3 -6). We have previously reported that octreotide treatment for 4 weeks normalised PRL levels in patients with acromegaly and hyperprolactinaemia (7). In accordance with these results treatment with dopamine-D2 agonists suppressed GH secretion more efficiently in acromegalic patients with hyperprolactinaemia compared with those with normoprolactinaemia (8).…”

Section: Introductionsupporting

confidence: 79%

Development of acromegaly in patients with prolactinomas

Andersen

Hagen²,

Frystyk³

et al. 2003

European Journal of Endocrinology

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Objectives: Patients with prolactinomas and patients with acromegaly often have heterogenous adenomas. In this study we have focused on patients with prolactinomas who developed acromegaly and acromegalic patients with hyperprolactinaemia. Our hypothesis is that some patients with hyperprolactinaemia may develop clinical acromegaly. Methods: We have included patients examined at department M, Odense University Hospital between 1996 and 2001. Seventy-eight patients with prolactinomas, 65 females and 13 males, with a median age (range) of 30 years (14-74) and 47 years (20-66), respectively, were included in the study. Results: In females and males the median prolactin (PRL) levels were 90 mg/l (27 -4700; normal values (NV) #23) and 1075 mg/l (24-6500; NV # 14), respectively. The PRL levels were significantly higher in males compared with females (P , 0.002). Fifty-nine patients with acromegaly, 24 females and 35 males, with a median age (range) of 45 years (24-70) and 53 years (19 -70), respectively, were included. Seven of the 24 females had hyperprolactinaemia, with PRL levels of 90 mg/l (27-494). Thirteen of the 35 males had hyperprolactinaemia with PRL levels of 47 mg/l (17-251). Three females with prolactinomas developed acromegaly clinically and biochemically. These patients had a normal low GH level and/or a normal IGF-I level at first diagnosis. Conclusions: Our findings suggest that there is a common group of patients with a pituitary adenoma who secrete PRL and GH unsynchronously. Some of these patients have clinical acromegaly at diagnosis and some patients diagnosed as prolactinomas will develop acromegaly. We suggest an annual IGF-I measurement as a screening test.

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Section: Introductionsupporting

confidence: 79%

Development of acromegaly in patients with prolactinomas

Andersen

Hagen²,

Frystyk³

et al. 2003

European Journal of Endocrinology

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“…These findings may be due in part to increased clearance of FA1 in acromegaly (49,50). Nevertheless, FA1 levels did decrease in six of seven acromegalic patients, who had a significant reduction in GH levels during 4 weeks of octreotide therapy (51). This effect on FA1 levels may be due to a decrease in GH or IGF1 levels per se or to a direct effect of octreotide on FA1 secretion (48).…”

Section: Serum Igf1 Levelsmentioning

confidence: 84%

MANAGEMENT OF ENDOCRINE DISEASE: GH excess: diagnosis and medical therapy

Andersen

2014

European Journal of Endocrinology

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Acromegaly is predominantly caused by a pituitary adenoma, which secretes an excess of GH resulting in increased IGF1 levels. Most of the GH assays used currently measure only the levels of the 22 kDa form of GH. In theory, the diagnostic sensitivity may be lower compared with the previous assays, which have used polyclonal antibodies. Many GH-secreting adenomas are plurihormonal and may co-secrete prolactin, TSH and a-subunit. Hyperprolactinaemia is found in 30-40% of patients with acromegaly, and hyperprolactinaemia may occasionally be diagnosed before acromegaly is apparent. Although trans-sphenoidal surgery of a GH-secreting adenoma remains the first treatment at most centres, the role of somatostatin analogues, octreotide long-acting repeatable and lanreotide Autogel as primary therapy is still the subject of some debate. Although the normalisation of GH and IGF1 levels is the main objective in all patients with acromegaly, GH and IGF1 levels may be discordant, especially during somatostatin analogue therapy. This discordance usually takes the form of high GH levels and an IGF1 level towards the upper limit of the normal range. Pasireotide, a new somatostatin analogue, may be more efficacious in some patients, but the drug has not yet been registered for acromegaly. Papers published on pasireotide have reported an increased risk of diabetes mellitus due to a reduction in insulin levels. Pegvisomant, the GH receptor antagonist, is indicated -alone or in combination with a somatostatin analogue -in most patients who fail to enter remission on a somatostatin analogue. Dopamine-D2-agonists may be effective as monotherapy in a few patients, but it may prove necessary to apply combination therapy involving a somatostatin analogue and/or pegvisomant.

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“…After screening the 1498 remaining articles for their title and abstract, the full text was evaluated for 37 studies. Of these, 10 RCTs [23][24][25][26][27][28][29][30][31][32] were included in the systematic review. All 10 studies composed the qualitative analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Just 1 of the 10 RCTs specified that only surgery-naive patients could be enrolled [23]. Three of the studies used a crossover design [24,25,29]. The proportion of men and women was comparable in the studies and among the studies.…”

Section: Study Characteristicsmentioning

confidence: 99%