Does Octreotide Treatment Improve the Surgical Results of Macro-Adenomas in Acromegaly? A Randomized Study

Summary

 It is not clear whether the pre-operative treatment of GH-secreting pituitary adenomas with Octreotide improves the surgical remission rates of acromegaly. In a prospective controlled study the results of transsphenoidal surgery in newly diagnosed GH-secreting macro-adenomas were compared in patients with (n=11, group A) and without (n=13, group B) preoperative Octreotide treatment. During the treatment with a daily dosage of 470±160 μg Octreotide for 16, 5±10 weeks, the GH- and IGF-1-values of group A dropped significantly from 38, 9±34, 1 to 6, 8±4, 9 μg/l and from 2, 7±1 to 1, 7±0, 7 arbitrary units respectively. The adenoma-shrinkage from 5, 9±5, 8 to 4, 7±4, 9 cm³ missed statistical significance by little. There was no statistically significant difference between the postoperative acromegaly remission rates of 55% in group A and 69% in group B. Of the adenomas that postoperatively were not in remission, 80% in group A and 75% in group B disclosed an infiltrative growth pattern not influenced by the Octreotide pretreatment. All other patients not cured presented with initial GH-values of >50μ{\rm g/l}. There was no statistically significant difference between the postoperative anterior pituitary function in the two patient groups. In this study Octreotide was not beneficial in improving the results of GH-secreting pituitary macro-adenoma surgery. However, larger prospective controlled studies are needed to address this issue.