The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

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The Dose of Somatostatin Analogues During Pre-Surgical Treatment is a Key Factor to Achieve Surgical Remission in Acromegaly

10.20944/preprints202107.0065.v1 ◽

2021 ◽

Author(s):

Marta Araujo-Castro ◽

Eider Pascual-Corrales ◽

Héctor Pian ◽

Ignacio Ruz-Caracuel ◽

Alberto Acitores Cancela ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Surgical Outcomes ◽

Somatostatin Analogues ◽

Transsphenoidal Approach ◽

Beneficial Effects ◽

Key Factor ◽

Long Acting ◽

First Time ◽

Endocrine Complications

Purpose: To determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: Retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: Most patients, 83.3% (n=40), harboured macroadenomas and 31.3% (n=15) invasive pitu-itary adenomas. Fourteen patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60-120] and 20 [range 20-30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and un-treatred patients (P>0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanre-otide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR=4.64, P=0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR=0.65, P=0.570)), independently of the doses and the duration of SSA treatment (P>0.05). Conclusions: The dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

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Advances in the medical and surgical treatment of pituitary adenomas: The role of long-acting somatostatin analogs

Journal of Endocrinological Investigation ◽

10.1007/bf03348882 ◽

1993 ◽

Vol 16 (6) ◽

pp. 449-460 ◽

Cited By ~ 12

Author(s):

R. Fahlbusch ◽

M. Giovanelli ◽

M. Buchfelder ◽

M. Losa

Keyword(s):

Surgical Treatment ◽

Pituitary Adenomas ◽

Somatostatin Analogs ◽

Long Acting

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A retrospective study of surgical treatment and outcome among women with adnexal torsion in eastern Taiwan from 2010 to 2015

PeerJ ◽

10.7717/peerj.5995 ◽

2018 ◽

Vol 6 ◽

pp. e5995 ◽

Cited By ~ 1

Author(s):

Ci Huang ◽

Mun-Kun Hong ◽

Tang-Yuan Chu ◽

Dah-Ching Ding

Keyword(s):

Risk Factor ◽

Abdominal Pain ◽

Retrospective Study ◽

Surgical Treatment ◽

Hospital Stay ◽

Tumor Size ◽

Surgical Outcomes ◽

Radical Surgery ◽

Older Age ◽

Adnexal Torsion

Background Adnexal torsion is a gynecologic emergency that requires surgical treatment. In this study, we reviewed the surgical outcomes of women with adnexal torsion in eastern Taiwan (Hualien county, area 4,629 km2, 330,000 residents). Methods This retrospective study included 42 women diagnosed with surgically-proven adnexal torsion from January 1, 2010, to September 31, 2015. We compared the symptoms, objective findings, and surgical outcomes of patients who underwent laparotomy or laparoscopy. Results The laparoscopy and laparotomy groups included 27 and 15 patients, respectively. The most common symptom and sign was abdominal pain, followed by nausea and vomiting. In all patients, an adnexal tumor was detected through ultrasound. The median and range of time from admission to surgery was 1.5 (1–11.5) and 1.0 (1–11) hours in the laparotomy and laparoscopy groups, respectively. Compared with those undergoing laparotomy, the smaller tumor size [7 (4.2–10) vs. 10 (7–17) cm] and shorter hospital stay [4 (2–8) vs. 6 (3–9) days] in patients undergoing laparoscopy were significantly noted, respectively (P < 0.01). No differences were observed in age, operative time, and blood loss between both groups. The surgeries performed were mostly detorsion with cystectomy and adnexectomy. The most common pathology was a simple ovarian cyst, followed by teratoma. Regarding the surgical types, older age is the only risk factor for radical surgery. Discussion Acute onset of abdominal pain with a presenting ovarian tumor is the most common feature of adnexal torsion. Laparoscopic surgical group showed a small tumor size and a short ER hospital stay than laparotomy. Older age is the risk factor for radical surgery.

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Curative surgical treatment after inefficient long-acting somatostatin analogues therapy of a tumor-induced osteomalacia

La Presse Médicale ◽

10.1016/j.lpm.2010.10.011 ◽

2011 ◽

Vol 40 (3) ◽

pp. 309-313 ◽

Cited By ~ 9

Author(s):

Arsene Mékinian ◽

Miriam Ladsous ◽

Anne-Sophie Balavoine ◽

Bruno Carnaille ◽

Sebastien Aubert ◽

...

Keyword(s):

Surgical Treatment ◽

Somatostatin Analogues ◽

Long Acting

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Is MRI follow-up relevant in patients with GH-secreting pituitary adenomas primarily treated and responsive to long-acting somatostatin analogues (SMSa)?

Acta Endocrinologica ◽

10.1530/eje-19-0681 ◽

2020 ◽

Vol 182 (1) ◽

pp. 123-130

Author(s):

Naia Grandgeorge ◽

Giovanni Barchetti ◽

Solange Grunenwald ◽

Fabrice Bonneville ◽

Philippe Caron

Keyword(s):

Pituitary Adenoma ◽

Visual Field ◽

Pituitary Adenomas ◽

First Generation ◽

Somatostatin Analogues ◽

Hormonal Control ◽

Tumor Shrinkage ◽

Normal Visual Field ◽

Long Acting

Objective Primary SMSa treatment can be associated with hormonal control and tumor shrinkage in patients with GH-secreting pituitary adenomas. The aim of this study was to evaluate whether regular MRI follow-up was necessary in patients with acromegaly-treated and responsive to first-generation long-acting SMSa. Patients and methods In this retrospective monocentric study we included patients with GH/IGF-1 hypersecretion and pituitary adenomas with normal visual field, primarily treated with first-generation long-acting SMSa between 1995 and 2015 and regularly monitored (clinical evaluation, GH/IGF-1 levels and pituitary MRI) for at least 3 years. Results We included 83 patients (32 men and 51 women, mean age at diagnosis 50 ± 12 years) with mean GH = 19.3 ± 25.6 ng/mL, IGF-1 = 284 ± 110% ULN and pituitary adenoma height = 12.9 ± 4.7 mm. Mean follow-up was 8.9 ± 4.9 years in 36 controlled patients and 2.0 ± 1.6 years in 47 partial responders to SMSa alone. No significant increase in pituitary adenoma height was observed. Pituitary adenoma height decreased significantly in controlled patients (diagnosis: 11.9 ± 4.8 mm, SMSa: 9.6 ± 3.3 mm, P < 0.001), and in partially responders (diagnosis: 13.6 ± 4.5 mm, SMSa: 11.5 ± 4.5 mm, P < 0.001). Conclusion During SMSa treatment, no significant increase in GH-secreting adenoma size was observed. Primary SMSa treatment was associated with a significantly decrease in adenoma height in our population. Our cohort data suggest that regular MRI follow-up does not seem relevant in patients with acromegaly who are responsive to SMSa treatment.

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Hepatoblastoma and Wilms’ tumour in an infant with Beckwith–Wiedemann syndrome and diazoxide resistant congenital hyperinsulinism

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-18-0146 ◽

2019 ◽

Vol 2019 ◽

Author(s):

Saurabh Uppal ◽

James Blackburn ◽

Mohammed Didi ◽

Rajeev Shukla ◽

James Hayden ◽

...

Keyword(s):

Surgical Resection ◽

Poor Response ◽

Somatostatin Analogues ◽

Early Infancy ◽

Congenital Hyperinsulinism ◽

List Type ◽

Wilms Tumour ◽

Intravenous Glucose ◽

Long Acting ◽

First Time

Summary Beckwith–Wiedemann syndrome (BWS) can be associated with embryonal tumours and congenital hyperinsulinism (CHI). We present an infant with BWS who developed congenital hepatoblastoma and Wilms’ tumour during infancy. The infant presented with recurrent hypoglycaemia requiring high intravenous glucose infusion and was biochemically confirmed to have CHI. He was resistant to diazoxide but responded well to octreotide and was switched to Lanreotide at 1 year of age. Genetic analysis for mutations of ABCC8 and KCNJ11 were negative. He had clinical features suggestive of BWS. Methylation-sensitive multiplex ligation-dependent probe amplification revealed hypomethylation at KCNQ1OT1:TSS-DMR and hypermethylation at H19 /IGF2:IG-DMR consistent with mosaic UPD(11p15). Hepatoblastoma was detected on day 4 of life, which was resistant to chemotherapy, requiring surgical resection. He developed Wilms’ tumour at 3 months of age, which also showed poor response to induction chemotherapy with vincristine and actinomycin D. Surgical resection of Wilms’ tumour was followed by post-operative chemotherapy intensified with cycles containing cyclophosphamide, doxorubicin, carboplatin and etoposide, in addition to receiving flank radiotherapy. We report, for the first time, an uncommon association of hepatoblastoma and Wilms’ tumour in BWS in early infancy. Early onset tumours may show resistance to chemotherapy. UPD(11p15) is likely associated with persistent CHI in BWS. Learning points: Long-acting somatostatin analogues are effective in managing persistent CHI in BWS. UPD(11)pat genotype may be a pointer to persistent and severe CHI. Hepatoblastoma and Wilms’ tumour may have an onset within early infancy and early tumour surveillance is essential. Tumours associated with earlier onset may be resistant to recognised first-line chemotherapy.

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