Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal.
OBJECTIVE
It is still unknown whether prolonged treatment with somatostatin analogs (SSTa) may cause a long-lasting disease remission in GH-secreting adenomas after drug discontinuation. The aim of the present study was to investigate the evolution of GH/IGF-I secretion and tumor mass after SSTa withdrawal in patients affected by acromegaly.


METHODS
A total of 27 patients with acromegaly (12 de novo and 15 previously operated) were treated with SSTa for a median period of 48 months and considered optimally controlled in hormonal and neuroradiological terms. None of them were previously irradiated.


METHODS
Basal GH, post-glucose GH nadir, IGF-I, clinical signs/symptoms, and metabolic parameters were evaluated after 12-16 weeks from drug withdrawal. Only patients who met the current criteria for disease remission remained in drug suspension being periodically re-evaluated for biochemical/clinical data and neuroradiological imaging.


RESULTS
After 12-16 weeks withdrawal, 15 of the 27 patients had disease relapse and restarted SSTa, while 12 were considered 'in disease remission' (44% of total). Glucose metabolism improved in both euglycemic and diabetic patients after short-term SSTa discontinuation. Only one of the ten patients who reached 24 weeks withdrawal showed biochemical disease recurrence. On the whole, five of the patients still in remission after 6 months have already prolonged the follow-up over 12 months (median: 24 months), without clinical and biochemical/neuroradiological evidence of disease recurrence.


CONCLUSIONS
These preliminary data indicate a successful withdrawal of SSTa at least in a subset of well-responsive patients with acromegaly and challenge the previously held concept that medical therapy is always a lifelong requirement.
Ronchi
Cristina L
CL
Unit of Endocrinology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F. Sforza, 35, 20122 Milan, Italy. cristina.ronchi@unimi.it
Rizzo
Erica
E
Lania
Andrea G
AG
Pivonello
Rosario
R
Grottoli
Silvia
S
Colao
Annamaria
A
Ghigo
Ezio
E
Spada
Anna
A
Arosio
Maura
M
Beck-Peccoz
Paolo
P
D000172:Acromegaly / Q000188:drug therapy* / Q000378:metabolism; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006728:Hormones / Q000627:therapeutic use; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006728:Hormones; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013004:Somatostatin