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Discontinuation of somatostatin analogs while acromegaly is in long-term remission

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Abstract

Purpose

We aimed to evaluate the disease activity of medically controlled patients with acromegaly after withdrawal of somatostatin receptor ligands (SRL).

Methods

Sixteen patients who were on a stable dose of SRL for more than 2 years and had at least 1 year of remission were included in the study. Five patients were on 10 mg, four were on 20 mg and three were on 30 mg of octreotide; whereas for lanreotide, one was on 60 mg, two were on 90 mg, and one was on 120 mg. All patients had received SRL with 28-day intervals. Basal GH, IGF1, glucose-suppressed GH levels were measured with 3-month intervals for a total of 12 months after withdrawal. Sella MRI evaluation was obtained at 6-month intervals. If the nadir GH level after glucose suppression was >1 ng/ml or IGF1 was above the normal limits during the follow-up period, SRL was restarted.

Results

Three months after stopping SRL, 10 (63 %) had biochemical disease recurrence. After 12 months of follow-up, in total 13 (81 %) of the patients recurred. The final basal GH levels before withdrawal, basal GH at month-3, and glucose suppressed GH levels were significantly lower in patients with sustained remission (p = 0.003, p < 0.001, and p = 0.001). Basal GH and glucose suppressed GH levels at month-3 were correlated with the basal GH levels at month-0 (r = 0.6, p = 0.008 and r = 0.5, p = 0.03).

Conclusion

The final GH levels prior to discontinuation of SRL should be taken into consideration in patients with acromegaly in long-term remission. Moreover, the first visit 3 months after withdrawal is critically important for determining the future status of remission.

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References

  1. Andersen M (2014) Management of endocrine disease: GH excess: diagnosis and medical therapy. Eur J Endocrinol 170(1):R31–R41. doi:10.1530/EJE-13-0532

    Article  CAS  PubMed  Google Scholar 

  2. Grasso LF, Pivonello R, Colao A (2012) Somatostatin analogs as a first-line treatment in acromegaly: when is it appropriate? Curr Opin Endocrinol Diabetes Obes 19(4):288–294. doi:10.1097/MED.0b013e328354af67

    Article  CAS  PubMed  Google Scholar 

  3. Ronchi CL, Boschetti M, Degli Uberti EC, Mariotti S, Grottoli S, Loli P, Lombardi G, Tamburrano G, Arvigo M, Angeletti G, Boscani PF, Beck-Peccoz P, Arosio M (2007) Efficacy of a slow-release formulation of lanreotide (Autogel) 120 mg) in patients with acromegaly previously treated with octreotide long acting release (LAR): an open, multicentre longitudinal study. Clin Endocrinol (Oxf) 67(4):512–519. doi:10.1111/j.1365-2265.2007.02917.x

    CAS  Google Scholar 

  4. Freda PU (2002) Somatostatin analogs in acromegaly. J Clin Endocrinol Metab 87(7):3013–3018. doi:10.1210/jcem.87.7.8665

    Article  CAS  PubMed  Google Scholar 

  5. Giustina A, Chanson P, Bronstein MD, Klibanski A, Lamberts S, Casanueva FF, Trainer P, Ghigo E, Ho K, Melmed S (2010) A consensus on criteria for cure of acromegaly. J Clin Endocrinol Metab 95(7):3141–3148. doi:10.1210/jc.2009-2670

    Article  CAS  PubMed  Google Scholar 

  6. Chanson P, Salenave S, Kamenicky P, Cazabat L, Young J (2009) Pituitary tumours: acromegaly. Best Pract Res Clin Endocrinol Metab 23(5):555–574. doi:10.1016/j.beem.2009.05.010

    Article  CAS  PubMed  Google Scholar 

  7. Holdaway IM, Bolland MJ, Gamble GD (2008) A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. Eur J Endocrinol 159(2):89–95. doi:10.1530/EJE-08-0267

    Article  CAS  PubMed  Google Scholar 

  8. Melmed S (2006) Medical progress: acromegaly. N Engl J Med 355(24):2558–2573. doi:10.1056/NEJMra062453

    Article  CAS  PubMed  Google Scholar 

  9. Schofl C, Franz H, Grussendorf M, Honegger J, Jaursch-Hancke C, Mayr B, Schopohl J (2013) Long-term outcome in patients with acromegaly: analysis of 1344 patients from the German Acromegaly Register. Eur J Endocrinol 168(1):39–47. doi:10.1530/EJE-12-0602

    Article  PubMed  Google Scholar 

  10. Andries M, Glintborg D, Kvistborg A, Hagen C, Andersen M (2008) A 12-month randomized crossover study on the effects of lanreotide Autogel and octreotide long-acting repeatable on GH and IGF-l in patients with acromegaly. Clin Endocrinol (Oxf) 68(3):473–480. doi:10.1111/j.1365-2265.2007.03067.x

    Article  CAS  Google Scholar 

  11. Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94(5):1509–1517. doi:10.1210/jc.2008-2421

    Article  CAS  PubMed  Google Scholar 

  12. Bevan JS (2005) Clinical review: the antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab 90(3):1856–1863. doi:10.1210/jc.2004-1093

    Article  CAS  PubMed  Google Scholar 

  13. Losa M, Ciccarelli E, Mortini P, Barzaghi R, Gaia D, Faccani G, Papotti M, Mangili F, Terreni MR, Camanni F, Giovanelli M (2001) Effects of octreotide treatment on the proliferation and apoptotic index of GH-secreting pituitary adenomas. J Clin Endocrinol Metab 86(11):5194–5200. doi:10.1210/jcem.86.11.7986

    Article  CAS  PubMed  Google Scholar 

  14. Sharma K, Patel YC, Srikant CB (1996) Subtype-selective induction of wild-type p53 and apoptosis, but not cell cycle arrest, by human somatostatin receptor 3. Mol Endocrinol 10(12):1688–1696. doi:10.1210/mend.10.12.8961277

    CAS  PubMed  Google Scholar 

  15. Ramirez C, Vargas G, Gonzalez B, Grossman A, Rabago J, Sosa E, Espinosa-de-Los-Monteros AL, Mercado M (2012) Discontinuation of octreotide LAR after long term, successful treatment of patients with acromegaly: is it worth trying? Eur J Endocrinol 166(1):21–26. doi:10.1530/EJE-11-0738

    Article  CAS  PubMed  Google Scholar 

  16. Ronchi CL, Rizzo E, Lania AG, Pivonello R, Grottoli S, Colao A, Ghigo E, Spada A, Arosio M, Beck-Peccoz P (2008) Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal. Eur J Endocrinol 158(1):19–25. doi:10.1530/EJE-07-0488

    Article  CAS  PubMed  Google Scholar 

  17. Vilar L, Fleseriu M, Naves LA, Albuquerque JL, Gadelha PS, Dos Santos Faria M, Nascimento GC, Montenegro RM Jr, Montenegro RM (2013) Can we predict long-term remission after somatostatin analog withdrawal in patients with acromegaly? Results from a multicenter prospective trial. Endocrine. doi:10.1007/s12020-013-0094-9

    PubMed  Google Scholar 

  18. Lorcy Y, Dejager S, Chanson P (2000) Time course of GH and IGF-1 levels following withdrawal of long-acting octreotide in acromegaly. Pituitary 3(3):193–197

    Article  CAS  PubMed  Google Scholar 

  19. Stewart PM, Stewart SE, Clark PM, Sheppard MC (1999) Clinical and biochemical response following withdrawal of a long-acting, depot injection form of octreotide (Sandostatin-LAR). Clin Endocrinol (Oxf) 50(3):295–299

    Article  CAS  Google Scholar 

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Acknowledgments

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey

    Esra Hatipoglu, Selma Bozcan & Pinar Kadioglu

Authors
  1. Esra Hatipoglu
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  2. Selma Bozcan
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  3. Pinar Kadioglu
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Correspondence to Pinar Kadioglu.

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Hatipoglu, E., Bozcan, S. & Kadioglu, P. Discontinuation of somatostatin analogs while acromegaly is in long-term remission. Pituitary 18, 554–560 (2015). https://doi.org/10.1007/s11102-014-0608-3

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  • DOI: https://doi.org/10.1007/s11102-014-0608-3

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