title: Treatment of acromegaly with octreotide: effectiveness and tolerability of its pulsatile administration by portable pump.
abstract: This study was undertaken to evaluate effectiveness and tolerability of octreotide administered in active acromegaly by pulsatile means and compare these data with intermittent three-times-a-day therapy. We studied 13 acromegalics with active disease. All patients received octreotide subcutaneously administered in a pulsatile way using a portable pump delivering 25 micrograms every 120 minutes and in an intermittent way (100 micrograms three times daily) (TID). From pretreatment values (56.5 +/- 13.4 micrograms/L) the 24-h integrated mean GH levels (IC-GH) were significantly reduced both during pulsatile and TID octreotide administration (P < 0.01). IC-GH was significantly lower during pulsatile therapy (17.0 +/- 5.2 micrograms/L) than during TID (22.0 +/- 11.5 micrograms/L; P < 0.05). Before octreotide, IGF-I levels were 669.8 +/- 85.7 micrograms/L; during octreotide therapy they were reduced in 12/13 patients (TID 340.2 +/- 41.5 micrograms/L, pulsatile 338.1 +/- 55.3 micrograms/L; P < 0.01). A correlation between IC-GH and IGF-I levels was observed only during TID administration of octreotide (R = 0.652; P < 0.05). The 24-hour GH pattern fluctuated widely before the start of octreotide therapy. During TID administration, GH levels tended to rise again before the following octreotide injection; this did not occur during pulsatile therapy. Side effects were fewer during pulsatile (15%) than TID (31%) octreotide administration (NS). Asymptomatic gallstones appeared in 1 patient. In conclusion subcutaneous pulsatile octreotide administration in acromegalic patients by means of a small portable pump seems able to produce, a steadier control of GH-IGF-I hypersecretion and fewer side effects than TID administration at same dosage.
authors.affiliation: DISEM, Cattedra di Endocrinologia, Università, Genova.
authors.forename: M
authors.initials: M
authors.lastname: Giusti
authors.forename: C M
authors.initials: CM
authors.lastname: Cuttica
authors.forename: G
authors.initials: G
authors.lastname: Cariola
authors.forename: S
authors.initials: S
authors.lastname: Valenti
authors.forename: P
authors.initials: P
authors.lastname: Sessarego
authors.forename: G
authors.initials: G
authors.lastname: Giordano
mesh_terms: D000172:Acromegaly / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D013006:Growth Hormone / Q000378:metabolism*; D006801:Humans; D007260:Infusion Pumps; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects; D011673:Pulsatile Flow; D013004:Somatostatin / Q000378:metabolism*
chemical_list: D013004:Somatostatin; D013006:Growth Hormone; D015282:Octreotide