[Somatotrope pituitary adenomas. Contribution of presurgical treatment with somatostatin analogs].
Presurgical treatment of somatotrope pituitary adenomas with somatostatin analogs is warranted by the efficacy of both octreotide and lanreotide in the treatment of acromegaly. This efficacy is expressed in terms of symptom relief, reduced growth hormone secretion, lower IGF-1 levels, and reduced tumor volume. Excepting encased microadenomas and macroademonmas, all patients with acromegaly should be given somatostatin analogs preoperatively. In addition, in certain cases of microadenomas, it may be advisable to postpone surgery while giving this medical treatment. The following protocol can be used: subcutaneous octreotide to initiate treatment in order to progressively increase dosage and minimize secondary digestive tract side effects, followed by long-acting formulations for 3 months. Treatment is assessed on clinical secretory efficacy and radiology changes in tumor volume as well as tolerance, taking into account for the exceptional cases of pancreatic or hepatic disturbances. In our own personal experience, preoperative treatment almost always improve symptomatology, reduces hormone levels in 70% of the cases and reduces tumor volume in all patients, by more than 30% in 20% of patients. As demonstrated by the body of published work on presurgical use of somatostatin analogs, this treatment improves post-surgery outcome. This treatment is also cost-effective.
Sadoul
J L
JL
Service d'Endocrinologie Maladies Métaboliques Médecine de la Reproduction. CHU de Nice, Hôpital de l'Archet, BP 3079, 06002 Nice Cedex 3.
D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D015282:Octreotide / Q000008:administration & dosage / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery; D011292:Premedication; D013004:Somatostatin / Q000031:analogs & derivatives*
D019382:Human Growth Hormone; D013004:Somatostatin; D015282:Octreotide