[Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry].
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.
Jaquet
Ph
P
Service d'Endocrinologie, Diabète et Maladies métaboliques, Hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille.
Cortet-Rudelli
Ch
Ch
Sassolas
G
G
Morange-Ramos
I
I
Chanson
P
P
Brue
Th
T
Andrieu
J-M
JM
Beckers
A
A
Bertherat
J
J
Borson-Chazot
F
F
Brassier
G
G
Caron
Ph
P
Cogne
M
M
Cottier
J-Ph
JP
Delemer
B
B
Dufour
H
H
Enjalbert
A
A
Figarella-Branger
D
D
Gaillard
R
R
Gueydan
M
M
Jan
M
M
Kuhn
J-M
JM
Raingeard
I
I
Regis
J
J
Roger
P
P
Rohmer
V
V
Sadoul
J-L
JL
Saveanu
A
A
Tabarin
A
A
Travers
N
N
Trouillas
J
J
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
D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D015282:Octreotide