Four years' treatment of resistant acromegaly with octreotide.
This study was designed to ascertain the long-term safety and efficacy profile of the somatostatin analogue octreotide as treatment of refractory acromegaly. Eight patients (aged 21-62 years) with persistent growth hormone (GH) elevation (duration 1-15 years) despite previous therapy were studied. Octreotide was given subcutaneously in increasing doses for the first year to a maximum of 500 micrograms three times daily. The dose then was reduced to 200 micrograms three times daily for the next 3 years. At annual assessments, 24-h GH profiles, insulin-like growth factor I (IGF-I) and a side-effect profile including gall-bladder ultrasound were studied. Oral glucose tolerance tests (75 g) were performed basally and after 6 months and 3 years of therapy. Haemoglobin A1 (HbA1) was also assessed. Side effects were recorded. Mean GH (+/- SEM) was 36.0 +/- 9 mU/l basally and was reduced significantly at all subsequent assessments on therapy (4-year mean, 9.4 +/- 2.1 mU/l). The IGF-I level also remained suppressed and was normalized in four of eight patients who remained on octreotide. Fasting plasma glucose and HbA1 were not changed by therapy but 2-h glucose was elevated after 6 months and 3 years (basal mean, 7.6 mmol/l (5.3-9.0 mmol/l); 3-year mean, 10.7 mmol/l (8.4-15.7 mmol/l); p < 0.05). Five patients developed gallstones and in three these had disappeared following 1 year of bile salt dissolution therapy. Octreotide continues to suppress serum GH and IGF-I long term without attenuation of effect. Gallstone formation is a major side effect.(ABSTRACT TRUNCATED AT 250 WORDS)
McKnight
J A
JA
Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland.
McCance
D R
DR
Sheridan
B
B
Atkinson
A B
AB
D000172:Acromegaly / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D002769:Cholelithiasis / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography
D006442:Glycated Hemoglobin; D013006:Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide