Short-term Preoperative Octreotide Treatment of GH-secreting Pituitary Adenoma: Predictors of Tumor Shrinkage

Abstract

Abstract. We reviewed the cases of 32 patients with growth hormone (GH)-secreting macroadenoma who underwent short-term octreotide treatment before transsphenoidal surgery to determine which types of adenoma the preoperative treatment were sensitive and whether predictors of tumor shrinkage could be identified. The effects of preoperative octreotide treatment, endocrinologic effect and effect on tumor volume in 32 patients were evaluated retrospectively in relation to tumor features on magnetic resonance images and responses to endocrinologic challenge tests. At a daily dose of 300 mg for 2-3 weeks, octreotide reduced serum GH and insulin-like growth factor-1 (IGF-1) levels to 31.9 % and 51.6% of pretreatment values, respectively, and led to a mean tumor volume of 68% of pretreatment volume in 52% of the patients. The endocrinologic effect and the effect on tumor volume were larger in Knosp grades 0-2 than in Knosp grades 3-4. Tumor shrinkage occurred significantly more often among patients that had a good response to both octreotide and bromocriptine challenge tests. For surgical removal of the tumor, the effect of reducing tumor to 68% of pretreatment volume will be beneficial for the macroadenomas of Knosp grades 1-2. Preoperative short-term octreotide treatment is effective for GH-secreting macroadeomas of Knosp grades 1-2 and a good response to both octreotide and bromocriptine challenge tests is a predictor of subsequent tumor shrinkage. These results will lead to more effective selection of patients for preoperative octreotide treatment.

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

“…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.…”

Investigation into the Efficacy and Safety of Octreotide LAR in Japanese Patients with Acromegaly: Shizuoka Study

“…Drug and additional therapeutic options include somatostatin analogs [3], dopaminergic agents [11], GH receptor antagonist that is capable of inhibiting the action of GH in the liver [12], and radiosurgery [13]. Recently, OCT-LAR has been tried as an initial therapy in treating acromegaly, administered alone as the principal therapy or in conjunction with surgery [14,15]. In Japan, OCT-LAR is a relatively new therapeutic option and few studies have reported its therapeutic effects in Japanese patients.…”

Ocena efektów leczenia analogami somatostatyny nieczynnych hormonalnie gruczolaków przysadki w porównaniu z akromegalią

“…Full response to somatostatin analogues is also understood as a ≥ 20% decrease in tumour volume in primary as well as in secondary therapy or at least stabilisation of tumour remnant in the case of second-line treatment [14]. Some authors suggest the importance of somatotropinomas pretreatment with somatostatin analogues prior to planned neurosurgery, which can be beneficial, especially in the aspect of tumour debulking [15].…”