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Endocrine

, Volume 52, Issue 3, pp 451–457 | Cite as

Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly

  • Marco LosaEmail author
  • Jens Bollerslev
Pros and Cons in Endocrine Practice

Abstract

The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and treatment individualized accordingly. The issue of SSA pre-treatment to improve surgical outcome is yet to be settled and further methodologically sound studies are probably necessary to clarify this point.

Keywords

Acromegaly Somatostatin analogues Pituitary neoplasms Pituitary surgery 

Abbreviations

SSA

First generation somatostatin analogue

DA

Dopamine agonist

Peg

Pegvisomant

TS

Transsphenoidal surgery

Pas

Pasireotide

Notes

Conflict of interest

The authors have nothing to declare.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San RaffaeleUniversità Vita-SaluteMilanItaly
  2. 2.Section of Specialized Endocrinology, Medical Clinic BOslo University HospitalOsloNorway
  3. 3.Faculty of MedicineUniversity in OsloOsloNorway

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