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- Title
Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly.
- Authors
Colao, Annamaria; Attanasio, Roberto; Pivonello, Rosario; Cappabianca, Paolo; Cavallo, Luigi M; Lasio, Giovanni; Lodrini, Alessandro; Lombardi, Gaetano; Cozzi, Renato
- Abstract
<bold>Context: </bold>Surgery is a cornerstone in the treatment of acromegaly, but its efficacy in large, invasive tumors is scant.<bold>Objective: </bold>The objective of this study was to investigate whether partial surgical removal of GH-secreting pituitary tumors enhances the response rate to somatostatin analogs (SSA; sc octreotide, slow-release octreotide, and lanreotide).<bold>Design: </bold>This was a multicenter, open, retrospective study.<bold>Setting: </bold>The study was performed at university hospitals.<bold>Subjects and Methods: </bold>Eighty-six patients (42 women and 44 men; age, 42 +/- 14 yr) with acromegaly were studied.<bold>Interventions: </bold>Patients underwent two courses of octreotide, lanreotide, or slow-release octreotide treatments before and after surgery of at least 6 months.<bold>Main Outcome Measure: </bold>The main outcome measure was normal IGF-I levels for age.<bold>Results: </bold>Presurgical SSA treatment significantly decreased GH and IGF-I levels in all patients. GH levels were less than 2.5 microg/liter in 12 patients (14%); IGF-I levels normalized in nine (10%). After surgery, GH and IGF-I levels further decreased in all patients; tumor removal was greater than 75% in 50 (58%), 50.1-75% in 21 (24%), 25.1-50% in 10 (12%), and less than 25% in five patients (6%). Preoperatively, pituitary function was impaired in 12 patients (14%). Postsurgical SSA treatment lowered GH levels to less than 2.5 microg/liter in 49 (56%) and normalized IGF-I levels in 48 patients (55%). The success rate was significantly increased compared with that before surgery (P < 0.0001). GH (r = -0.48; P < 0.0001) and IGF-I levels (r = -0.38; P = 0.0003) after postsurgery SSA treatment correlated with the amount of tumor surgically removed. After surgery, pituitary function was impaired in 28 patients (32.6%) and was improved in 12 patients (13.9%). The cumulative prevalence of pituitary deficiency did not change during the study (normal function from 40 to 42%; deficiency from 60 to 58%).<bold>Conclusions: </bold>Surgical tumor removal (>75%) enhances the response to SSAs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.
- Publication
Journal of Clinical Endocrinology & Metabolism, 2006, Vol 91, Issue 1, p85
- ISSN
0021-972X
- Publication type
journal article
- DOI
10.1210/jc.2005-1208