title: Discontinuation of somatostatin analogs while acromegaly is in long-term remission.
abstract: OBJECTIVE
  We aimed to evaluate the disease activity of medically controlled patients with acromegaly after withdrawal of somatostatin receptor ligands (SRL).
  
  
  METHODS
  Sixteen patients who were on a stable dose of SRL for more than 2 years and had at least 1 year of remission were included in the study. Five patients were on 10 mg, four were on 20 mg and three were on 30 mg of octreotide; whereas for lanreotide, one was on 60 mg, two were on 90 mg, and one was on 120 mg. All patients had received SRL with 28-day intervals. Basal GH, IGF1, glucose-suppressed GH levels were measured with 3-month intervals for a total of 12 months after withdrawal. Sella MRI evaluation was obtained at 6-month intervals. If the nadir GH level after glucose suppression was >1 ng/ml or IGF1 was above the normal limits during the follow-up period, SRL was restarted.
  
  
  RESULTS
  Three months after stopping SRL, 10 (63%) had biochemical disease recurrence. After 12 months of follow-up, in total 13 (81%) of the patients recurred. The final basal GH levels before withdrawal, basal GH at month-3, and glucose suppressed GH levels were significantly lower in patients with sustained remission (p = 0.003, p < 0.001, and p = 0.001). Basal GH and glucose suppressed GH levels at month-3 were correlated with the basal GH levels at month-0 (r = 0.6, p = 0.008 and r = 0.5, p = 0.03).
  
  
  CONCLUSIONS
  The final GH levels prior to discontinuation of SRL should be taken into consideration in patients with acromegaly in long-term remission. Moreover, the first visit 3 months after withdrawal is critically important for determining the future status of remission.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Hatipoglu
authors.forename: Selma
authors.initials: S
authors.lastname: Bozcan
authors.forename: Pinar
authors.initials: P
authors.lastname: Kadioglu
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D005260:Female; D005951:Glucose Tolerance Test; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism* / Q000473:pathology; D015282:Octreotide / Q000627:therapeutic use*; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D012074:Remission Induction; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D018931:Antineoplastic Agents, Hormonal; D010456:Peptides, Cyclic; C060347:lanreotide; D019382:Human Growth Hormone; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D015282:Octreotide