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.
First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
M
M
Tamura
N
N
Yokoyama
Y
Y
Abe
N
N
Sera
T
T
Tominaga
K
K
Ashizawa
E
E
Ejima
T
T
Kiriyama
M
M
Uetani
A
A
Kuwayama
S
S
Nagataki
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