title: [Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry].
abstract: From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05).
  
  
  RESULTS
  46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions.
authors.affiliation: Service d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille.
authors.forename: Ph
authors.initials: P
authors.lastname: Jaquet
authors.forename: Ch
authors.initials: Ch
authors.lastname: Cortet-Rudelli
authors.forename: G
authors.initials: G
authors.lastname: Sassolas
authors.forename: I
authors.initials: I
authors.lastname: Morange-Ramos
authors.forename: P
authors.initials: P
authors.lastname: Chanson
authors.forename: Th
authors.initials: T
authors.lastname: Brue
authors.forename: J-M
authors.initials: JM
authors.lastname: Andrieu
authors.forename: A
authors.initials: A
authors.lastname: Beckers
authors.forename: J
authors.initials: J
authors.lastname: Bertherat
authors.forename: F
authors.initials: F
authors.lastname: Borson-Chazot
authors.forename: G
authors.initials: G
authors.lastname: Brassier
authors.forename: Ph
authors.initials: P
authors.lastname: Caron
authors.forename: M
authors.initials: M
authors.lastname: Cogne
authors.forename: J-Ph
authors.initials: JP
authors.lastname: Cottier
authors.forename: B
authors.initials: B
authors.lastname: Delemer
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.forename: A
authors.initials: A
authors.lastname: Enjalbert
authors.forename: D
authors.initials: D
authors.lastname: Figarella-Branger
authors.forename: R
authors.initials: R
authors.lastname: Gaillard
authors.forename: M
authors.initials: M
authors.lastname: Gueydan
authors.forename: M
authors.initials: M
authors.lastname: Jan
authors.forename: J-M
authors.initials: JM
authors.lastname: Kuhn
authors.forename: I
authors.initials: I
authors.lastname: Raingeard
authors.forename: J
authors.initials: J
authors.lastname: Regis
authors.forename: P
authors.initials: P
authors.lastname: Roger
authors.forename: V
authors.initials: V
authors.lastname: Rohmer
authors.forename: J-L
authors.initials: JL
authors.lastname: Sadoul
authors.forename: A
authors.initials: A
authors.lastname: Saveanu
authors.forename: A
authors.initials: A
authors.lastname: Tabarin
authors.forename: N
authors.initials: N
authors.lastname: Travers
authors.forename: J
authors.initials: J
authors.lastname: Trouillas
mesh_terms: D000172:Acromegaly / Q000209:etiology / Q000601:surgery; D000236:Adenoma / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D002426:Cavernous Sinus / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D007016:Hypophysectomy / Q000379:methods; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015282:Octreotide / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012042:Registries; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D015282:Octreotide