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Clinical and biochemical response following withdrawal of a long‐acting, depot injection form of octreotide (Sandostatin‐LAR ® )
Author(s) -
Stewart Paul M.,
Stewart Susan E.,
Clark Penny M. S.,
Sheppard Michael C.
Publication year - 1999
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.1999.00660.x
Subject(s) - acromegaly , medicine , octreotide , endocrinology , somatostatin , gastroenterology , growth hormone , hormone
OBJECTIVE Monthly injections of Sandostatin‐LAR® have been shown to be an effective therapy for patients with acromegaly. Because of an ongoing need to assess a patients response to definitive therapy such as surgery and/or radiotherapy, we aimed to evaluate GH levels and acromegaly symptom scores in patients withdrawing from Sandostatin‐LAR®. DESIGN AND PATIENTS 12 patients with acromegaly previously treated with Sandostatin‐LAR®, 20–40 mg intramuscularly every 28 ( n = 9) or 42 ( n = 3) days for 12–36 months were studied at monthly intervals for 4 months following the withdrawal of the drug. MEASUREMENTS Hourly fasting serum GH measurements between 0800 h and 1200 h, serum IGF‐1 and symptom scores were undertaken at 4,8,12 and 16 weeks following the last injection of Sandostatin‐LAR®. MRI/CT scans of the pituitary were undertaken at 16 weeks and compared to scans taken on Sandostatin‐LAR® within the previous 10 months. RESULTS Serum GH rose progressively from 7.7 (1.5 to 14.6) (median (range)) mIU/l at 4 weeks to 9.9 (1.5–21.8), to 12.6 (4.9–31.9) ( P < 0.05 vs 4 weeks) and to 13.1 (6.0–39.1) mIU/l ( P < 0.002) at 8, 12 and 16 weeks, respectively, following cessation of Sandostatin‐LAR®. IGF‐1 rose from 38.5 (12.6–73.8) nmol/l at 4 weeks to 62.4 (37.4–159) at 16 weeks ( P < 0.002) and mean symptom score (comprising headache, sweating, arthralgia, paraesthesiae, tiredness) from 4.0 (0 to 10) (4 weeks) to 4.5 (0–9) (8 weeks) to 6.0 (2–10) (12 weeks) to 6.5 (4–12) (16 weeks, P < 0.05). Individual GH profiles indicated a rise in GH in 5/12 patients between weeks 4–8 and between weeks 8–12 in a further 5/12 patients. There were no changes in pituitary tumour size following discontinuation of Sandostatin‐LAR®. CONCLUSIONS GH and symptom scores rise progressively following discontinuation of Sandostatin‐LAR® in acromegalic patients. However, GH and symptom scores remain suppressed in some patients for at least 8 weeks following cessation of Sandostatin‐LAR®. We suggest that a withdrawal period of 3 months from Sandostatin‐LAR® is required in order to perform a meaningful re‐assessment of GH and clinical status.