title: Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly.
abstract: The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and treatment individualized accordingly. The issue of SSA pre-treatment to improve surgical outcome is yet to be settled and further methodologically sound studies are probably necessary to clarify this point.
authors.affiliation: Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San Raffaele, Università Vita-Salute, Via Olgettina 60, 20132, Milan, Italy. losa.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Losa
authors.affiliation: Section of Specialized Endocrinology, Medical Clinic B, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University in Oslo, Oslo, Norway.
authors.forename: Jens
authors.initials: J
authors.lastname: Bollerslev
mesh_terms: D000172:Acromegaly / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D000236:Adenoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D055317:Evidence-Based Practice; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D015282:Octreotide / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D057234:Preoperative Period; D013004:Somatostatin / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D013004:Somatostatin; D015282:Octreotide
keywords: Acromegaly; Pituitary neoplasms; Pituitary surgery; Somatostatin analogues