[Preoperative administration of a slow releasing somatostatin analog (SR-lanreotide, BIM 23014) in patients with acromegaly in the course of GH-releasing adenoma].
To evaluate the therapeutic efficacy of slow releasing analogue of somatostatin (SR-Lanreotide) in the pretreatment for GH-releasing adenomas, especially macroadenomas. During the last four years (between January 1996 and December 1999) the authors carried out 382 transsphenoidal operations for to various lesions. There were 169 acromegalic patients in this group. 82 of them received, as pretreatment, the slow releasing analogue of somatostatin (SR-Lanreotide, BIM 23014) in a dose of 30 mg every 14 days for 3 months (6 injections). There were 55 women and 27 men (range 25-68, mean age 44.8 years, SD +/- 10 years) operated on by one experienced neurosurgeon. The concentrations of serum GH--70.5 micrograms/l (range 5.3-500 micrograms/l, SD +/- 83.9 micrograms/l) and IGF-I--1302 micrograms/l (range 610-2030 micrograms/l, SD +/- 360.7 micrograms/l) were high. Out of these 82 patients 79 had macroadenomas with suprasellar and parasellar extension. The volume of the tumours was calculated according to the formula of Di Chiro-Nelson. The mean volume of the tumour was 4146.9 mm3 (range 213.5-38595.3 mm3, SD +/- 5675.9 mm3). The response to the pretreatment suppression of the serum GH, IGF-I level and shrinkage of the tumours--were evaluated before surgery. Second MR examination was performed in 38 pretreated patients. During the Lanreotide treatment mean serum GH level decreased from 70.5 to 15.6 micrograms/l (p < 0.0001), mean serum IGF-I concentration decreased from 1302 to 787 micrograms/l and mean volume of the tumour decreased from 5662 to 2326 mm3 (p < 0.0001). During surgery, tumours were observed to be softer, had liquid consistency and were easier removed. 57 patient (69.5%) who underwent surgery had GH below 5 micrograms/l and were cured. Transsphenoidal microsurgical resection of pituitary adenomas is the primary treatment for acromegaly. Lanreotide pretreatment significantly decreased mean serum GH and IGF-I level, shrinks the tumour and make it much softer and easier to be removed.
Zieliński
G
G
Kliniki Neurochirurgii Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej im. Bolesława Szareckiego w Warszawie.
Podgórski
J K
JK
Koziarski
A
A
Siwik
J
J
Zgliczyński
W
W
Wieliczko
W
W
D000172:Acromegaly / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D000236:Adenoma / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D012898:Autacoids / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D013006:Growth Hormone / Q000031:analogs & derivatives / Q000097:blood / Q000378:metabolism*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000494:pharmacology* / Q000627:therapeutic use*; D010902:Pituitary Gland / Q000378:metabolism / Q000601:surgery; D011300:Preoperative Care; D017526:Receptor, IGF Type 1 / Q000097:blood; D013004:Somatostatin / Q000031:analogs & derivatives / Q000494:pharmacology* / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D012898:Autacoids; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin; D013006:Growth Hormone; D017526:Receptor, IGF Type 1