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Six‐month preoperative octreotide treatment in unselected, de novo patients with acromegaly: effect on biochemistry, tumour volume, and postoperative cure
Author(s) -
Carlsen Sven M.,
Svartberg Johan,
Schreiner Thomas,
Aanderud Sylvi,
Johannesen Øivind,
Skeie Svein,
LundJohansen Morten,
Fougner Stine L.,
Bollerslev Jens
Publication year - 2011
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 - 10.1111/j.1365-2265.2011.03982.x
Subject(s) - octreotide , acromegaly , medicine , somatostatin , hormone , endocrinology , gastroenterology , growth hormone
Summary Objective Treatment with somatostatin analogues is the primary medical treatment of acromegaly. Controversies still exist whether acute octreotide effect predicts long‐term biochemical effects, tumour regression or surgical cure. This prospective study investigates effect of 6‐month treatment with octreotide long‐acting repeatable (LAR) on insulin‐like growth factor‐1 (IGF‐1) and growth hormone (GH) levels, pituitary function, tumour regression and postoperative cure in de novo acromegalic patients. Design and methods After a baseline evaluation including fasting hormone levels, MRI scan and an acute 50 μg octreotide test, 32 patients were treated with octreotide LAR 20 mg every 28th day for 6 months before surgery. Treatment effects on IGF‐1 and GH levels, serum hormone levels and tumour volume were monitored. Surgical cure was evaluated 3 months postoperatively. Results Mean tumour volume reduction was 35%, in one‐third of the patients more than 50%, while approximately one‐third achieved biochemical remission evaluated by normalized IGF‐1 levels. The GH reduction following an acute octreotide test was 81 ± 19% and associated with long‐term GH reduction ( r = 0·78, P < 0·0005). However, neither acute ( r = 0·29, P = 0·12) nor the long‐term octreotide effect ( r = 0·11, P = 0·58) on GH levels was associated with tumour volume reduction and did not predict subsequent surgical cure. Conclusion Six months of long‐acting octreotide using a fixed dose, 1/3 of the patients came in biochemical remission, while 2/3 had significant tumour reduction. Moreover, an acute effect of octreotide seemed to be a prerequisite for long‐term effect.