Preoperative treatment of growth hormone-producing pituitary adenoma with continuous subcutaneous infusion of octreotide.
Preoperative therapy with octreotide, a long-acting somatostatin analog, suppresses GH hypersecretion, shrinks GH-producing tumors and leads to an improvement in subsequent surgical remission in acromegalic patients. A continuous infusion of octreotide has demonstrated more persistent suppression of GH secretion than intermittent injections, and only a few studies were reported on the effect of the tumor shrinkage with a continuous infusion of a small dose of octreotide. We therefore investigated the preoperative effects of small doses of octreotide (120-240 micrograms/day) administered continuously (with a subcutaneous infusion pump) over a short period (2 or 4 weeks) in nine untreated acromegalic patients. Octreotide therapy resulted in suppression of serum GH and IGF-1 concentrations in 8 out of 9 patients and reduction in pituitary tumor size measured by MRI in all patients (by 7.9 to 38.5%). In particular, considerable reduction in tumor size (more than 20%) occurred in 6 of 9 patients. In three patients assessed serially throughout the preoperative period, reduction in tumor size was noted within only one week after the start of octreotide therapy and reduction rate more than 20% was obtained within the first two weeks. In one patient, suprasellar tumor expansion totally disappeared after such therapy. Our results indicate that short-term continuous subcutaneous infusion of a small dose of octreotide results in not only inhibition of GH hypersecretion but also shrinkage of tumor size prior to surgery.
Tamura
M
M
First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Yokoyama
N
N
Abe
Y
Y
Sera
N
N
Tominaga
T
T
Ashizawa
K
K
Ejima
E
E
Kiriyama
T
T
Uetani
M
M
Kuwayama
A
A
Nagataki
S
S
D000236:Adenoma / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D000328:Adult; D018931:Antineoplastic Agents, Hormonal; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D011292:Premedication; D011446:Prospective Studies
D018931:Antineoplastic Agents, Hormonal; D019382:Human Growth Hormone; D015282:Octreotide