Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates

Losa, Marco; Mortini, Pietro; Urbaz, Laura; Ribotto, Paolo; Castrignanò, Tristana; Giovanelli, Massimo

doi:10.3171/jns.2006.104.6.899

Cited by 74 publications

(33 citation statements)

References 35 publications

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“…Presurgical SSA administration has been reported to improve surgical outcome and reduce complications (Annamalai et al 2013), but these findings were not confirmed by other authors (Losa et al 2006). Randomised controlled studies exploring the potential benefits are scarce (Carlsen et al 2008, Shen et al 2010, Fougner et al 2014.…”

Section: Surgerycontrasting

confidence: 41%

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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Section: Surgerycontrasting

confidence: 41%

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

Căpățînă¹,

Wass²

2015

Journal of Endocrinology

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“…On the other hand, low resection rates of the invasive macroadenomas are reported [5,24]. As indicated by several reports, presurgical long-acting octreotide decreases tumor volume [15,16,[25][26][27][28][29], and so presurgical long-acting octreotide should have greater therapeutic value, if the drug relieves the macroade- resolve this important management question for acromegaly.…”

Section: Discussionmentioning

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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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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“…Shen and coworkers reported that pre-surgical treatment of invasive macroadenomas with octreotide LAR increased total resection rates and short-term remission rates (both GH and IGF-1 normalized) vs no pre-treatment; however, remission rates during long-term follow-up of the pre-treated group showed no advantage (Shen et al 2010). A retrospective analysis of 286 patients revealed that surgical remission rates were not significantly different whether octreotide or lanreotide was given pre-operatively or not (Losa et al 2006). A recent meta-analysis suggested a statistically significant effect of pre-operative medical therapy on surgical outcome when three prospective controlled trials were analysed, with a pooled odds ratio for biochemical cure with somatostatin analogue pre-treatment of 3.62 (95% CI: 1.88-6.96) (Pita-Gutierrez et al 2013).…”

Section: Clinical Utility As First-line Therapymentioning

confidence: 99%

Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future

Öberg¹,

Lamberts²

2016

Endocrine-Related Cancer

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Acromegaly is a hormonal disorder that arises when the pituitary gland secretes excess growth hormone (GH), which in turn stimulates a concomitant increase in serum insulin-like growth factor 1 (IGF-1) levels. Gastroenteropancreatic neuroendocrine tumours (GEP-NET) constitute a heterogeneous group of tumours that can secrete serotonin and a variety of peptide hormones that may cause characteristic symptoms known as carcinoid syndrome or other symptoms and hormonal hypersecretion syndromes depending on the tumour's site of origin. Current medical therapy for the treatment of acromegaly and GEP-NET involves the administration of somatostatin analogues that effectively suppress excess hormone secretion. After its discovery in 1979, octreotide became the first synthetic biologically stable somatostatin analogue with a short-acting formulation of octreotide introduced into clinical practice in the late 1980s. Lanreotide, another somatostatin analogue, became available in the mid-1990s initially as a prolonged-release formulation administered every 10 or 14 days. Long-acting release formulations of both octreotide (Sandostatin LAR and Novartis) and lanreotide (Somatuline Autogel, Ipsen), based on microparticle and nanoparticle drug-delivery technologies, respectively, were later developed, which allowed for once-monthly administration and improved convenience. First-generation somatostatin analogues remain one of the cornerstones of medical therapy in the management of pituitary and GEP-NET hormone hypersecretion, with octreotide having the longest established efficacy and safety profile of the somatostatin analogue class. More recently, pasireotide (Signifor), a next-generation multireceptor-targeted somatostatin analogue, has emerged as an alternative therapeutic option for the treatment of acromegaly. This review summarizes the development and clinical success of somatostatin analogues.

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Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates

Abstract: At present, the routine use of presurgical therapy with somatostatin analogs for patients with acromegaly cannot be recommended.

Cited by 74 publications

References 35 publications

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

60 YEARS OF NEUROENDOCRINOLOGY: Acromegaly

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

Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future

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