, Volume 22, Issue 2, pp 187–194 | Cite as

Pretreatment with somatostatin analogs does not affect the anesthesiologic management of patients with acromegaly

  • Marco LosaEmail author
  • Carmine Antonio Donofrio
  • Marco Gemma
  • Lina Raffaella Barzaghi
  • Pietro Mortini



Acromegaly may be associated with an increased risk of complex intraoperative management and anesthetic complications. No study addressed whether pretreatment with somatostatin receptor ligands (SRLs) affects anesthesiologic management.


We studied 211 consecutive acromegalic patients who had a recorded intraoperative computerized anesthetic record (ICAR) available for analysis. Ninety-six (45.5%) patients were SRL-pretreated while 115 patients were treatment naïve.


Treatment with SRLs reduced mean basal growth hormone level from 23.8 ± 4.2 to 5.9 ± 1.3 µg/L. Normalization of insulin-like growth factor-1 was achieved in 26 patients (27.1%). The frequency of comorbidities at surgery was similar in the two groups. Five patients with difficult intubation were naïve (4.3%) as compared with 5 SRL-pretreated patients (5.2%; P = 1.0). ICAR registration did not show any significant change of intraoperative vital parameters in the two groups of patients as well as in the intraoperative utilization of drugs. Total duration of anesthesia and surgery were similar in the two groups. Four patients with an intraoperative adverse event were naïve (3.5%) as compared with 4 SRL-pretreated patients (4.2%; P = 1.00). Remission of disease occurred in 83 of 114 naïve patients (72.8%) and in 57 of 93 SRL-pretreated patients (61.3%; P = 0.11).


SRL-pretreatment of patients with acromegaly had no significant impact on intraoperative anesthesiologic management. Despite a better Cormack–Lehane score in SRL-pretreated than in naïve patients, the rate of difficult intubation was similar in both groups. SRL-pretreatment did not affect the rate of surgical remission or complications as well.


Acromegaly Pituitary surgery Pituitary neoplasm Anesthesia Somatostatin analogs 



We thank Dr. Snider for his contribution to the analysis of data obtained from the ICAR.


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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JAH (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951CrossRefGoogle Scholar
  2. 2.
    McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF (2012) Pituitary centers of excellence. Neurosurgery 71:916–924 discussion 924–926CrossRefGoogle Scholar
  3. 3.
    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 94:1509–1517CrossRefGoogle Scholar
  4. 4.
    Wass JA, Turner HE, Adams CB (1999) The importance of locating a good pituitary surgeon. Pituitary 2:51–54CrossRefGoogle Scholar
  5. 5.
    Kreutzer J, Vance ML, Lopes MB, Laws ER Jr (2001) Surgical management of GH-secreting pituitary adenomas: an outcome study using modern remission criteria. J Clin Endocrinol Metab 86:4072–4077CrossRefGoogle Scholar
  6. 6.
    Nomikos P, Buchfelder M, Fahlbusch R (2005) The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical ‘cure’. Eur J Endocrinol 152:379–387CrossRefGoogle Scholar
  7. 7.
    Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr (2013) Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 98:3190–3198CrossRefGoogle Scholar
  8. 8.
    Mortini P, Barzaghi LR, Albano L, Panni P, Losa M (2018) Microsurgical therapy of pituitary adenomas. Endocrine 59:72–81CrossRefGoogle Scholar
  9. 9.
    Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS, Melmed S, Mortini P, Wass J, Giustina A (2017) Pituitary Society, Expert Group on Pituitary tumors: criteria for the definition of pituitary tumor centers of excellence (PTCOE): a Pituitary Society statement. Pituitary 20:489–498CrossRefGoogle Scholar
  10. 10.
    Bevan JS (2005) Clinical review: the antitumoral effects of somatostatin analog therapy in acromegaly. J Clin Endocrinol Metab 90:1856–1863CrossRefGoogle Scholar
  11. 11.
    Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz D (2005) Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 90:4465–4473CrossRefGoogle Scholar
  12. 12.
    Coalo A, Auriemma RS, Pivonello R (2016) The effects of somatostatin analogue therapy on pituitary tumor volume in patients with acromegaly. Pituitary 19:210–221CrossRefGoogle Scholar
  13. 13.
    Fahlbusch R, Giovanelli M, Buchfelder M, Losa M (1993) Advances in the medical and surgical treatment of pituitary adenomas: the role of long-acting somatostatin analogs. J Endocrinol Invest 16:449–460CrossRefGoogle Scholar
  14. 14.
    Colao A, Ferone D, Cappabianca P, del Basso De Caro, ML, Marzullo P, Monticelli A, Alfieri A, Merola B, Calì A, de Divitiis E, Lombardi G (1997) Effect of octreotide pretreatment on surgical outcome in acromegaly. J Clin Endocrinol Metab 82:3308–3314CrossRefGoogle Scholar
  15. 15.
    Biermasz NR, van Dulken H, Roelfsema F (1999) Direct postoperative and follow-up results of transsphenoidal surgery in 19 acromegalic patients pretreated with octreotide compared to those in untreated matched controls. J Clin Endocrinol Metab 84:3551–3555CrossRefGoogle Scholar
  16. 16.
    Losa M, Mortini P, Urbaz L, Ribotto P, Castrignanò T, Giovanelli M (2006) Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates. J Neurosurg 104:899–906CrossRefGoogle Scholar
  17. 17.
    Carlsen SM, Lund-Johansen M, Schreiner T, Aanderud S, Johannesen O, Svartberg J, Cooper JG, Hald JK, Fougner SL, Bollerslev J, Preoperative Octreotide Treatment of Acromegaly study group (2008) Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab 93:2984–2990CrossRefGoogle Scholar
  18. 18.
    Mao ZG, Zhu YH, Tang HL, Wang DY, Zhou J, He DS, Lan H, Luo BN, Wang HJ (2010) Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol 162:661–666CrossRefGoogle Scholar
  19. 19.
    Albarel F, Castinetti F, Morange I, Gulbert N, Graillon T, Dufour H, Brue T (2018) Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly. Pituitary 21:615–623CrossRefGoogle Scholar
  20. 20.
    Losa M, Bollerslev J (2016) Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly. Endocrine 52:451–457CrossRefGoogle Scholar
  21. 21.
    Schmitt H, Buchfelder M, Raderspiel-Troger M, Fahlbusch R (2000) Difficult intubation in acromegalic patients: incidence and predictability. Anesthesiology 93:110–114CrossRefGoogle Scholar
  22. 22.
    Seidman PA, Kofke WA, Policare R, Young M (2000) Anaesthetic complications of acromegaly. Br J Anaesth 84:179–182CrossRefGoogle Scholar
  23. 23.
    Khan ZH, Rasouli MR (2009) Intubation in patients with acromegaly: experience in more than 800 patients. Eur J Anaesth 26:354–355CrossRefGoogle Scholar
  24. 24.
    Friedel ME, Johnston DR, Singhal S, Al Khalili K, Farrell CJ, Evans JJ, Nyquist GG, Rosen MR (2013) Airway management and perioperative concerns in acromegaly patients undergoing endoscopic transsphenoidal surgery for pituitary tumors. Otolaryngol Head Neck Surg 149:840–844 (2013)CrossRefGoogle Scholar
  25. 25.
    Zhang Y, Guo X, Pei L, Zhang Z, Tan G, Xing B (2017) High levels of IGF-1 predict difficult intubation of patients with acromegaly. Endocrine 57:326–336CrossRefGoogle Scholar
  26. 26.
    Donofrio CA, Losa M, Gemma M, Giudice L, Barzaghi LR, Mortini P (2016) Safety of transsphenoidal microsurgical approach in patients with an ACTH-secreting pituitary adenoma. Endocrine 58:303–311CrossRefGoogle Scholar
  27. 27.
    Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M (2005) Results of transsphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 56:1222–1233CrossRefGoogle Scholar
  28. 28.
    Petrini F, Accorsi A, Adrario E, Agrò F, Amicucci G, Antonelli M, Azzeri F, Baroncini S, Bettelli G, Cafaggi C, Cattaneo D, Chinelli E, Corbanese U, Corso R, Della Puppa A, Di Filippo A, Facco E, Favaro R, Favero R, Frova G, Giunta F, Giurati G, Giusti F, Guarino A, Iannuzzi E, Ivani G, Mazzon D, Menarini M, Merli G, Mondello E, Muttini S, Nardi G, Pigna A, Pittoni G, Ripamonti D, Rosa G, Rosi R, Salvo I, Sarti A, Serafini G, Servadio G, Sgandurra A, Sorbello M, Tana F, Tufano R, Vesconi S, Villani A, Zauli M (2005) Gruppo di Studio SIAARTI “Vie Aeree Difficili”; IRC e SARNePI; Task Force: recommendations for airway control and difficult airway management. Minerva Anestesiol 71:617–657Google Scholar
  29. 29.
    Colao A, Bronstein MD, Freda P, Gu F, Shen C-C, Gadhela M, Fleseriu M, van der Lely AJ, Farrall AJ, Hermosillo Reséndiz K, Ruffin M, Chen Y, Sheppard M, on behalf of the Pasireotide C2305 study Group (2014) Pasireotide versus Octreotide in acromegaly: a head-to-head superiority study. J Clin Endocrinol Metab 99:791–799CrossRefGoogle Scholar
  30. 30.
    Annamalai AK, Webb A, Kandasamy N, Elkhawad M, Moir S, Khan F, Maki-Petaja K, Gayton EL, Strey CH, O’Toole S, Ariyaratnam S, Halsall DJ, Chaudhry AN, Berman L, Scoffings DJ, Antoun NM, Dutka DP, Wilkinson IB, Shneerson JM, Pickard JD, Simpson HL, Gurnell M (2013) A comprehensive study of clinical, biochemical, radiological, vascular, cardiac, and sleep apnea parameters in an unselected cohort of patients with acromegaly undergoing presurgical somatostatin receptor ligand therapy. J Clin Endocrinol Metab 98:1040–1050CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pituitary Unit of the Division of Neurosurgery, IRCCS San RaffaeleVita-Salute UniversityMilanItaly
  2. 2.Anesthesia and Intensive Care UnitFatebenefratelli HospitalMilanItaly

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