Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system
- 981 Downloads
Whether the preoperative use of somatostatin analogues (SA) improves surgical outcomes in acromegaly is still a matter of debate.
We conducted a systematic review of randomized, controlled trials that compared the short-term outcomes of preoperative use of SA (Pre-SA) with direct TSS (No-SA) for the treatment of newly diagnosed acromegaly.
Embase, Pubmed, Lilacs, and Central Cochrane were used as our data sources. The primary outcomes were no need for any adjuvant treatment 3 months after surgery, based on biochemical results (GH nadir after OGTT <1 μg/L and normal IGF-1 for age and gender), quality of life and mortality. The included trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
A total of 2.099 references were identified and two reviewers independently screened the titles and abstracts. From the 14 potentially eligible studies, four were included and ten were excluded due to lack of randomization or different outcomes. A pool of 261 patients was randomly assigned to Pre-SA or No-SA. Meta-analysis of IGF1 normalization showed a significant difference in favor of Pre-SA (RR 2.47; 95 % CI 1.66, 3.77). Adding a GH nadir on OGTT ≤1 μg/L, we found a RR of 2.15 (95 % CI 1.39, 3.33). Quality of evidence for no need of adjuvant postoperative treatment was moderate, but for improving quality of life was very low and for mortality was absent.
Pre-SA increases the chance of biochemical control of acromegaly 3 months after TSS in patients harboring GH-secreting pituitary macroadenomas.
KeywordsAcromegaly Somatostatin analogues Systematic review Meta-analysis
We thank Dr. Gordon H. Guyatt to help us to apply the GRADE system in this Systematic Review and Dr. Sergio Alberto Rupp de Paiva to motivate us to use the GRADE approach. This work was supported by Sao Paulo State Research Foundation (FAPESP); Grant # 2011/20517-2.
Conflict of interest
V. S. Nunes and C. L. Boguszewski receive consulting fees from Novartis and travel expenses from Ipsen. J. M. S. Correa, M. E. S. Puga and E. M. K. Silva have no relationships to disclose.
- 3.Vieira Neto L, Abucham J, de Araujo LA et al (2011) Recommendations of Neuroendocrinology Department from Brazilian Society of Endocrinology and Metabolism for diagnosis and treatment of acromegaly in Brazil. Arq Bras Endocrinol Metabol 55:91–105. doi: 10.1590/S0004-27302011000200001 PubMedCrossRefGoogle Scholar
- 6.Stevenaert A, Harris AG, Kovacs K, Beckers A (1992) Presurgical octreotide treatment in acromegaly. Metabolism 51–58Google Scholar
- 12.The Cochrane Collaboration (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. Version 510 [updated March 2011] Cochrane Collab. www.cochrane-handbook.org
- 15.Carlsen SM, Lund-Johansen M, Schreiner T et al (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 93:2984–2990. doi: 10.1210/jc.2008-0315 PubMedCrossRefGoogle Scholar
- 19.Carlsen SM, Svartberg J, Schreiner T et al (2011) Six-month preoperative octreotide treatment in unselected, de novo patients with acromegaly: effect on biochemistry, tumour volume, and postoperative cure. Clin Endocrinol (Oxf) 74:736–743. doi: 10.1111/j.1365-2265.2011.03982.x CrossRefGoogle Scholar
- 21.Plöckinger U, Quabbe H-J (2005) Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study. Acta Neurochir (Wien) 147:485–493; discussion 493. doi: 10.1007/s00701-005-0511-9