title: Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide.
abstract: The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on GH and IGF-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94 +/- 14.01 SD years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to OGTT and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 microg/l [IQR: 420-600] to 340 microg/l [IQR: 230-460] at 6 months (p = 0.01), to 400 microg/l [IQR: 222.4-600] at 12 months (p = 0.48), to 396 microg/l [IQR: 318-468] at 30 months (p = 0.49), to 482 microg/l [308-580] at 40 months (p = 0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p = 0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p = 0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p = 0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
authors.forename: Demet Ozgil
authors.initials: DO
authors.lastname: Yetkin
authors.forename: Serife Nur
authors.initials: SN
authors.lastname: Boysan
authors.forename: Ozay
authors.initials: O
authors.lastname: Tiryakioglu
authors.forename: Ayse Serap
authors.initials: AS
authors.lastname: Yalin
authors.forename: Pinar
authors.initials: P
authors.lastname: Kadioglu
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000601:surgery; D000236:Adenoma / Q000188:drug therapy* / Q000601:surgery; D000328:Adult; D015897:Comorbidity; D003692:Delayed-Action Preparations / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy* / Q000601:surgery; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000188:drug therapy*; D015282:Octreotide / Q000008:administration & dosage* / Q000009:adverse effects; D016879:Salvage Therapy; D013004:Somatostatin / Q000031:analogs & derivatives*; D017211:Treatment Failure
chemical_list: D003692:Delayed-Action Preparations; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D015282:Octreotide