Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center
| Autor: | Federico Gatto, Gianluigi Zona, Diego Ferone, Massimo Giusti, Elena Nazzari, Nicola Luigi Bragazzi, Renato Spaziante, Susanna Bacigaluppi, Diego Criminelli Rossi, Pasquale Anania, Giulia Benvegnu |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment Neurosurgery 030209 endocrinology & metabolism Hypopituitarism Pituitary neoplasm Single Center Radiosurgery 03 medical and health sciences Young Adult 0302 clinical medicine Endocrinology Hormone Antagonists Acromegaly Medicine Humans Pituitary Neoplasms Insulin-Like Growth Factor I Child Pituitary adenomas Aged Retrospective Studies business.industry IGF-1 Somatostatin analogs Retrospective cohort study Middle Aged medicine.disease Combined Modality Therapy Surgery Diabetes and Metabolism Radiation therapy Treatment Outcome Growth Hormone Female Growth Hormone-Secreting Pituitary Adenoma business Somatostatin 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Endocrine. 51(3) |
| ISSN: | 1559-0100 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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