Presurgical octreotide treatment in acromegaly.
The effects of octreotide pretreatment before surgery were assessed in 48 acromegalic patients who underwent trans-sphenoidal surgery to remove pituitary adenoma, and compared with 107 patients who did not receive octreotide before surgery. Pretreated patients received octreotide 100 micrograms, thrice daily for 3 to 6 weeks (group 1), or 100 to 500 micrograms, thrice daily for 3 to 39 months (group 2). Total remission of symptoms was seen in 54%. Partial remission of symptoms occurred in 39%. Octreotide pretreatment reduced plasma GH levels by > or = 50% in all patients. GH levels were reduced to < 2 micrograms/1 in 3/14 group 1 cases and 13/34 group 2 cases. Tumour shrinkage occurred in 56.5% of patients. Marked tumour shrinkage (> 25%) occurred in more group 2 patients (10/32 vs 1/14). The tumour was soft in 39 patients, firm in 6 and hard in 3 cases. Soft consistency aided surgical removal of adenomas. Remission was greater in enclosed adenomas than in invasive tumours in both octreotide pretreated and nonpretreated acromegalics (76 vs 30%). Remission was more likely if the adenoma was less than 16 mm. Remission rate was significantly greater (p < 0.05) in all octreotide pretreated than in untreated patients for enclosed adenoma, but not for invasive adenoma. Octretide pretreatment can be recommended for three to four months prior to surgery.
Stevenaert
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Department of Neurosurgery and Endocrinology, University Hospital, Liège, Belgium.
Beckers
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D000172:Acromegaly / Q000188:drug therapy / Q000601:surgery*; D000236:Adenoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D011292:Premedication; D012074:Remission Induction
D013006:Growth Hormone; D015282:Octreotide