Therapeutic efficacy of a somatostatin analogue (SMS 201–995) in active acromegaly

Tolis, G.; Yotis, A; Pozo, E. del; Pitoulis, Spyros

doi:10.3171/jns.1986.65.1.0037

Cited by 42 publications

(13 citation statements)

References 10 publications

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“…Early work in this field has shown that the conventional formulation of octreotide (usually administered 2–3 times daily by subcutaneous injection) was effective both in relieving symptoms and lowering GH as well as IGF-1 concentrations [10, 11]. The inhibition of GH and IGF-1 in long-term trials with octreotide LAR [12] is generally better than that achieved with the conventional formulation of octreotide administered by the subcutaneous route.…”

Section: Overall Efficacy Of Somatostatin Analogsmentioning

confidence: 99%

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

et al. 2006

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Relief of symptoms can be achieved following surgery for growth hormone (GH)-secreting adenomas, as well as after pharmacological therapy with somatostatin analogs. Recently, long-acting somatostatin analog depot formulations, octreotide LAR and lanreotide SR have become available. Somatostatin analogs control GH/insulin-like growth factor (IGF)-1 excess, induce tumor shrinkage in a high proportion of patients, improve symptoms of acromegaly with relatively limited side effects and are successfully administered in patients not suitable for surgery. Furthermore, preoperative somatostatin analogs have been suggested to improve outcome for tumors with limited invasiveness, while surgical tumor debulking in cases that are, at least partially, somatostatin resistant, increases the achievement of normal IGF-1 levels by postoperative somatostatin analog treatment. Effective control of hypertension, as well as diabetes, is mandatory in order to reduce the increased vascular morbidity/mortality. Control of GH/IGF-1 excess generally improves glucose metabolism. Somatostatin analogs improve insulin sensitivity, exerting, however, a concomitant direct inhibitory effect on insulin secretion, with a net balance leaning towards a deterioration in glucose homeostasis. As a result, oral insulin secretagogues (and/or insulin) should probably be preferred to insulin sensitizers in acromegalic patients developing diabetes while on somatostatin analogs. Nevertheless, glucose tolerance remains normal in most of the nondiabetic acromegalic patients, while diabetic acromegalic patients on insulin are at risk for hypoglycemia during initiation of somatostatin analog therapy. Although successful management of acromegaly has been associated with improvement in morphological and functional parameters of cardiomyopathy, limited and conflicting information is available regarding the effect on blood pressure control. Contradictory results have also been reported regarding sleep hypopnea or apnea in treated acromegalic patients. As acromegalic skeletal abnormalities are rather irreversible, apneic episodes may persist after normalization of hormonal levels. Aggressive therapy, including surgery, pharmacological treatment and, in some cases, pituitary irradiation, aiming at normalization of IGF-1 levels, is required for arthropathy management. Some improvement in pain, crepitus and range of motion has been observed after treatment with somatostatin analogs. Information on the impact of disease control, either by surgery or somatostatin analog treatment, on gonadal function is limited. Finally, the link between the hormonal/biochemical and the psychiatric/psychological features of acromegaly, as well as a potential basis for positive effects of somatostatin analog therapy remain unclear.

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Section: Overall Efficacy Of Somatostatin Analogsmentioning

confidence: 99%

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

et al. 2006

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“…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.…”

Section: Discussionmentioning

confidence: 87%

“…[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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1994

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“…12 In recent years, octreotide proved to be a more potent drug in suppressing GH hypersecretion with 45% of patients reaching normal values. 26,27 Our experience with long-acting somatostatin analog in three patients with continued GH elevation after either adenomectomy alone (one case) or adenomectomy and radiotherapy. (two cases) has been encouraging.…”

Section: Discussionmentioning

confidence: 99%

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

et al. 1995

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A series of 18 consecutive patients with growth hormone-secreting pituitary adenoma treated by surgery were analyzed retrospectively. Apart from an unusually high male-to-female ratio, the demographic data, clinical presentation, and endocrinological findings were similar to those reported by other authors. There were four (22%) microadenomas and 14 (78%) macroadenomas with a large intracranial extension in three patients and gross radiological evidence of invasion of surrounding structures in three others. The mean preoperative basal serum growth hormone level was 48.6 ± 45.4 ng/mL. The tumor resection was carried out via a transsphenoidal route in 15 cases and via frontotemporal craniotomy in the remaining three. One patient died from pulmonary embolism ten days after transcranial tumor resection. The mean postoperative basal growth hormone level was 10.0 ± 10.4 ng/mL. The growth hormone level decreased below 5 ng/mL in six of the 17 survivors (35%) directly after surgery. Nine patients received adjuvant postoperative treatment as follows: dopamine agonist in four, somatostatin analog in one, radiotherapy in one, and a combined drug and radiotherapy in three. The postoperative follow-up period ranged between two and 55 months (mean 28.6). At last follow-up examination, 10 (59%) patients had normalized their basal growth hormone level. Two patients developed postoperative anterior pituitary lobe insufficiency and a third had permanent diabetes insipidus.Acromegaly is a serious medical disorder resulting from the unrestrained secretion of growth hormone (GH). The long-term effects of sustained excess of GH on metabolism and cardiovascular system are deleterious and include diabetes mellitus, arterial hypertension, heart disease, as well as an increased risk of malignancy.1-3 The mortality associated with untreated or partially treated acromegaly is double to threefold the expected rate in healthy subjects matched for age. 4,5 Acromegaly may be caused by a variety of pathological conditions, but GH-secreting pituitary adenomas are by far the most common. 6 The medical literature is rich with reports covering various aspects of this lesion; 4,[7][8][9][10][11][12] however, published data about experiences with this tumor and its management in Saudi Arabia have been lacking entirely. This has prompted us to review all cases of GH-secreting pituitary adenomas which were operated upon in our institution during a period of 10 years and to compare our findings with the relevant data from the literature. Material and MethodsDuring a ten-year period starting in October 1982, 18 consecutive patients with previously untreated growth hormone-secreting pituitary adenoma underwent surgical removal of their tumors at the Neurosurgical Division of King Khalid University Hospital. They constituted 20.5% of all cases of pituitary adenoma treated there during the same period. The diagnosis of a pituitary adenoma was confirmed in all cases with computed tomography (CT) scan and, more recently, magnetic resonance imaging (MRI). A de...

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Therapeutic efficacy of a somatostatin analogue (SMS 201–995) in active acromegaly

Cited by 42 publications

References 10 publications

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

Medical Treatment of Acromegaly: Comorbidities and Their Reversibility by Somatostatin Analogs

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

Growth Hormone Secreting Pituitary Adenoma: Clinical Aspects and Surgical Outcome

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