Abstract
Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.
Highlights
Is associated with a two-fold risk mortality, mainly due to neoplastic disease, and cardiovascular, respiratory and metabolic complications [1]
The surgical remission rate is stabilized around 60–75% in large series from expert centres, but the overall remission rates decreased to 40–60% for macroadenomas and even 10–20% for invasive macroadenomas [5]
20 patients were treated with somatostatin analogues (SSAs) in the preoperative stage (Octreotide LAR intramuscular, 6 cases; Lanreotide Autogel subcutaneous, 14 cases) for at least 3 months preoperatively
Summary
Is associated with a two-fold risk mortality, mainly due to neoplastic disease, and cardiovascular, respiratory and metabolic complications [1]. Some studies showed that only macroadenoma and invasive macro- or giant PAs benefited from the pre-treatment with SSAs [14,15], whereas others reported advantage in all acromegalic patients [16,17]. Some studies showed no apparent beneficial effect of SSAs pre-treatment on surgical outcome [18,19]. The issue of SSAs pre-treatment to improve surgical remission and/or reduce perioperative morbidity is yet to be settled and further studies are necessary to clarify this question. The aim of our study was to evaluate whether presurgical treatment with SSAs affects surgical outcomes in terms of surgical remission rates and complications in patients with acromegaly.
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