Place of Preoperative Treatment of Acromegaly with Somatostatin Analog on Surgical Outcome: A Systematic Review and Meta-Analysis

Raul M Luque,Francisco Pita-Gutierrez,Sonia Pertega-Diaz,Lara Pena,Fernando Cordido,Gloria Lugo,Salvador Pita-Fernandez,Susana Sangiao-Alvarellos

doi:10.1371/journal.pone.0061523

Raul M Luque, Francisco Pita-Gutierrez + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0061523

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Journal: PloS one	Publication Date: Apr 25, 2013
Citations: 105	License type: CC BY 4.0

Affiliation: University of A Coruña

Abstract

ContextTranssphenoidal neurosurgery is the accepted first-line treatment of acromegaly in the majority of patients. Previous studies addressing preoperative somatostatin analog (SSA) treatment and subsequent surgical cure rates are conflicting, reporting either benefits or no significant differences.ObjectiveThe aim of this study, based on a meta-analysis of all published reports, was to investigate whether treatment with SSA before surgery improves the surgical outcome of acromegaly.Data SourcesAll studies of preoperative treatment of acromegaly with SSA were systematically reviewed up to December 2011. We searched the Medline, Embase, Cochrane and Google Scholar electronic databases. Study Selection: The primary endpoint was the biochemical postoperative cure rate. We identified 286 studies, out of which 10 studies (3.49%) fulfilling the eligibility criteria were selected for analysis; five retrospective studies with a control group, two prospective non-randomized trials, and three prospective controlled trials. The meta-analysis was conducted using the random-effects model.Data ExtractionData were extracted from published reports by two independent observers. Data Synthesis: A borderline effect was detected in the analysis of all of the trials with control groups, with a pooled odds ratio (OR) for biochemical cure with SSA treatment of 1.62 (95% CI, 0.93–2.82). In the analysis of the three prospective controlled trials, a statistically significant effect was idenfified OR: 3.62 (95% CI, 1.88–6.96).ConclusionsPreoperative treatment with SSA og GH-secreting pituitary adenomas shows a significant improvement on surgical results. This meta-analysis suggests that in centers without optimal results all patients with a GH-secreting pituitary macroadenoma should be treated with a long-acting SSA prior to surgical treatment.

Highlights

Is a rare but severe endocrine disease due to excess GH production, caused by a pituitary adenoma in the vast majority of cases
Preoperative treatment with somatostatin analog (SSA) og GH-secreting pituitary adenomas shows a significant improvement on surgical results
This meta-analysis suggests that in centers without optimal results all patients with a GH-secreting pituitary macroadenoma should be treated with a long-acting SSA prior to surgical treatment

Summary

Introduction

Is a rare but severe endocrine disease due to excess GH production, caused by a pituitary adenoma in the vast majority of cases (around 98%). The incidence of acromegaly is approximately 5 cases per million per year and the prevalence is 60 cases per million [1]. The diagnosis is often preceded by around 10 years of active but unrecognized disease [2]. Somatotroph adenomas are monoclonal in origin and develop as a result of genetic changes. Over 90% of patients with acromegaly have benign monoclonal pituitary adenomas, which are not surrounded by hyperplasic tissue [3]. Other contributors that could facilitate the expansion of the somatotroph tumor cells are hypothalamic GHRH or somatostatin, paracrine growth factors and ghrelin [2,4]. Current treatment for acromegaly includes neurosurgery, radiotherapy and medical therapy with dopamine agonists, somatostatin analog (SSA), and the GH-receptor antagonist pegvisomant [2,8,9,10]

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