Preoperative Octreotide Treatment in Newly Diagnosed Acromegalic Patients with Macroadenomas Increases Cure Short-Term Postoperative Rates: A Prospective, Randomized Trial

• Published in: The journal of clinical endocrinology and metabolism Vol. 93; no. 8; pp. 2984 - 2990
• Main Authors: Carlsen, Sven M., Lund-Johansen, Morten, Schreiner, Thomas, Aanderud, Sylvi, Johannesen, Øivind, Svartberg, Johan, Cooper, John G., Hald, John K., Fougner, Stine L., Bollerslev, Jens
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.08.2008; Endocrine Society
• Subjects: Acromegaly; Acromegaly - blood; Acromegaly - drug therapy; Acromegaly - surgery; Adult; Aged; Biological and medical sciences; Combined Modality Therapy; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Glucose Tolerance Test; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-like growth factor I; Insulin-Like Growth Factor I - analysis; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Octreotide; Octreotide - therapeutic use; Patients; Pituitary Neoplasms - pathology; Pituitary Neoplasms - surgery; Postoperative Complications - epidemiology; Prospective Studies; Surgery; Surgical outcomes; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Short term; Peptide hormone; Diseases of the osteoarticular system; Acromegaly; Octreotide; Early stage; Adenoma; Neuropeptide; Prospective; Randomization; Surgery; Clinical trial; Somatostatin; Benign neoplasm; Nutritional status; Human; Postoperative; Nutrition; Cure; Rate; Nutrition disorder; Patient; Metabolic diseases; Increase; Treatment; Analog; Pituitary diseases; Preoperative; Endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2008-0315

Context: Surgery is the primary treatment of acromegaly. However, it often fails to cure the patient. New strategies that improve surgical outcome are needed. Objective: Our objective was to investigate whether 6-month preoperative treatment with octreotide improves the surgical outcome in newly diagnosed acromegalic patients. Patients: During a 5-yr period (1999–2004), all newly diagnosed acromegalic patients between 18 and 80 yr of age in Norway were screened and invited to participate in the study. A total of 62 patients was included in the Preoperative Octreotide Treatment of Acromegaly study. Research Design and Methods: After a baseline evaluation, patients were randomized directly to transsphenoidal surgery (n = 30) or pretreatment with octreotide (n = 32) 20 mg im every 28th day for 6 months before transsphenoidal surgery. Cure was evaluated 3 months postoperatively primarily by IGF-I levels. Results: According to the IGF-I criteria, 14 of 31 (45%) pretreated patients vs. seven of 30 (23%) patients with direct surgery were cured by surgery (P = 0.11). In patients with microadenomas (≤10 mm), one of five (20%) pretreated vs. three of five (60%) with direct surgery were cured (P = 0.52). In patients with macroadenomas, 13 of 26 (50%) pretreated vs. four of 25 (16%) with direct surgery were cured (P = 0.017). Conclusions: Six-month preoperative octreotide treatment might improve surgical cure rate in newly diagnosed acromegalic patients with macroadenomas. These results have to be confirmed in future studies.