title: Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center.
abstract: First-line treatment of patients with growth hormone secreting adenomas is surgical resection. Disease control can be obtained by surgery (one or multiple steps), in case followed by medical treatment or adjuvant radiation therapy (radiosurgery or radiotherapy). The impact of pre-surgical treatment with somatostatin analogs (SSAs) on surgical outcome is still controversial. The aim of this study is to retrospectively evaluate the impact of SSA pre-treatment on biochemical outcome and post-surgical hypopituitarism in a consecutive surgical series from a single referral centre, with data covering 17 years' experience and to investigate the possible predictive value of early postoperative insulin-like factor 1 (IGF-I) on long-term biochemical control. Data from 68 acromegalic patients were revised. Endocrinological long-term follow-up (minimum 6 months) was available for 57 patients. Eighty-eight percent of patients received a single-step surgical treatment (single surgery, with or without adjuvant medical therapy). The remaining 12% underwent a multi-step strategy: redo-surgery (three macroadenomas) and/or radiation (four macro- and two microadenomas). Pre-surgical SSA treatment was performed in 77.9% and resulted in a significant lowering of basal IGF-I values (p = 0.0001). Early post-surgical IGF-I was significantly lower in patients biochemically controlled with single surgery alone (p = 0.016) and after overall treatment strategies (p = 0.005). Normalization of GH and IGF-I was obtained in 56.1%, and normalization of either one of them in 27.8% of patients. No major surgery-related complications occurred. Post-treatment hypopituitarism occurred in 11.9% and was lower in SSA pre-treated patients. Our results well compare with other recently published series. Very early post-surgical IGF-I improvement might be a useful predictor for biochemical disease control. Moreover, our results suggest that pre-surgical treatment with somatostatin analogs seems to prevent hypopituitarism.
authors.affiliation: Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy.|Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Bacigaluppi
authors.affiliation: Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy.|Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Gatto
authors.affiliation: Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Anania
authors.affiliation: School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy.
authors.forename: Nicola Luigi
authors.initials: NL
authors.lastname: Bragazzi
authors.affiliation: Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy.
authors.forename: Diego Criminelli
authors.initials: DC
authors.lastname: Rossi
authors.affiliation: Anaesthesiology, Department of Emergency (DEA), IRCCS San Martino-IST, Genova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Benvegnu
authors.affiliation: Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Nazzari
authors.affiliation: Department of Neurosurgery, University of Salerno, Salerno, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Spaziante
authors.affiliation: Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy.|Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Giusti
authors.affiliation: Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy.|Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Ferone
authors.affiliation: Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy. zonagianluigi@iol.it.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Zona
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000097:blood; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000188:drug therapy / Q000601:surgery; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000188:drug therapy / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006727:Hormone Antagonists; D013004:Somatostatin; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone
keywords: Acromegaly; IGF-1; Neurosurgery; Pituitary adenomas; Somatostatin analogs