title: Long-term treatment of acromegaly with lanreotide: evidence of increased serum parathormone concentration.
abstract: The somatostatin analogue lanreotide is effective in reducing growth hormone levels in patients with acromegaly. Acromegaly is characterized by calcium homeostasis alterations. The aim of our study was to evaluate the effects of lanreotide on bone turnover markers in a group of acromegalic patients and to verify a possible increase of intact parathormone (iPTH) levels in a transient or persistent way. Serum GH, IGF-I and serum and urinary markers of bone metabolism were measured before treatment and on months 3 and 24. In short-term treatment (3 months), lanreotide significantly decreased GH, IGF-I, serum calcium, osteocalcin and alkaline phosphatase levels, but increased iPTH level (49 +/- 16.7 vs pre-treatment 28.3 +/- 7.6 ng/L, p<0.001). During long-term study (24 months) GH and IGF-I were significantly still low; serum calcium and alkaline phosphatase levels returned to pre-treatment levels. iPTH level was significantly still higher compared with pre-treatment (46.4 +/- 9.2 vs 28.3 +/- 7.6 ng/L, p<0.05). No changes were seen in serum albumin, creatinine and vitamin D during short and long term treatment. The changes of most bone markers during lanreotide treatment can be explained by the decrease of GH and IGF-I. The increase of iPTH concentration suggests that lanreotide has ulterior and long-standing actions on calcium homeostasis: intestinal malabsorption of calcium due to the lanreotide could contribute to this "secondary" hyperparathyroidism. The clinical relevance of these long-standing effects needs to be further investigated.
authors.affiliation: Internal Medicine, Endocrinology Section, University of Brescia, 25100 Brescia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cappelli
authors.forename: Elena
authors.initials: E
authors.lastname: Gandossi
authors.forename: Barbara
authors.initials: B
authors.lastname: Agosti
authors.forename: Bruno
authors.initials: B
authors.lastname: Cerudelli
authors.forename: Davide
authors.initials: D
authors.lastname: Cumetti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Castellano
authors.forename: Ilenia
authors.initials: I
authors.lastname: Pirola
authors.forename: Elvira
authors.initials: E
authors.lastname: De Martino
authors.forename: Enrico Agabiti
authors.initials: EA
authors.lastname: Rosei
mesh_terms: D000172:Acromegaly / Q000097:blood* / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D002112:Calcifediol; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D006909:Hydroxyproline / Q000652:urine; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood*; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D010710:Phosphates / Q000097:blood / Q000652:urine; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use*
chemical_list: D010281:Parathyroid Hormone; D010456:Peptides, Cyclic; D010710:Phosphates; C060347:lanreotide; D015675:Osteocalcin; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002112:Calcifediol; D006909:Hydroxyproline; D002118:Calcium