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.
Department of Neurosurgery and Endocrinology, University Hospital, Liège, Belgium.
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Stevenaert
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Beckers
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