title: Short-term preoperative octreotide treatment for TSH-secreting pituitary adenoma.
abstract: Preoperative control of hyperthyroidism in patients with TSH-secreting pituitary adenomas (TSHoma) may avoid perioperative thyroid storm. Perioperative administration of octreotide may control hyperthyroidism, as well as shrink tumor size. The effects of preoperative octreotide treatment were assessed in a large number of patients with TSHomas. Of 81 patients who underwent surgery for TSHoma at Toranomon Hospital between January 2001 and May 2013, 44 received preoperative short-term octreotide. After excluding one patient because of side effects, 19 received octreotide as a subcutaneous injection, and 24 as a long-acting release (LAR) injection. Median duration between initiation of octreotide treatment and surgery was 33.5 days. Octreotide normalized free T4 in 36 of 43 patients (84%) and shrank tumors in 23 of 38 (61%). Length of octreotide treatment did not differ significantly in patients with and without hormonal normalization (p=0.09) and with and without tumor shrinkage (p=0.84). Serum TSH and free T4 concentrations, duration of treatment, incidence of growth hormone (GH) co-secretion, results of octreotide loading tests, form of administration (subcutaneous injection or LAR), tumor volume, and tumor consistency did not differ significantly in patients with and without hormonal normalization and with and without tumor shrinkage. Short-term preoperative octreotide administration was highly effective for TSHoma shrinkage and normalization of excess hormone concentrations, with tolerable side effects.
authors.affiliation: Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Fukuhara
authors.forename: Kentaro
authors.initials: K
authors.lastname: Horiguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishioka
authors.forename: Hisanori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Takeshita
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Naoko
authors.initials: N
authors.lastname: Inoshita
authors.forename: Shozo
authors.initials: S
authors.lastname: Yamada
mesh_terms: D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D007279:Injections, Subcutaneous; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010902:Pituitary Gland / Q000187:drug effects / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care / Q000009:adverse effects; D012189:Retrospective Studies; D012306:Risk; D013958:Thyroid Crisis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013972:Thyrotropin / Q000097:blood / Q000378:metabolism*; D013974:Thyroxine / Q000097:blood; D047368:Tumor Burden / Q000187:drug effects
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003692:Delayed-Action Preparations; D013972:Thyrotropin; D013974:Thyroxine; D015282:Octreotide