Faculty Opinions recommendation of Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal.

BackgroundSomatostatin analogs (SA) are the cornerstone in the medical treatment of acromegaly, used as either primary or adjunctive therapy. In particular, SA are effective in inducing the biochemical remission of the disease and tumor shrinkage, although only few cases of complete disappearance of the pituitary tumor in patients treated with SA as long-acting formulations have been reported. SA withdrawal has been demonstrated to keep safe levels of GH and IGF1 at least in a small subset of patients well responsive to SA, although it is generally followed by disease recurrence after several months.Case reportA 61-year-old female patient bearing a very large GH-secreting pituitary macroadenoma was treated with 12-month lanreotide Autogel (ATG), at the initial dose of 120 mg/28 days. After 3 months, GH and IGF1 levels were fully normalized, to prolong the administration interval from 28 to 56 days. After 6 months of treatment, a significant tumor shrinkage (90% of baseline size) was observed, whereas GH and IGF1 excess was still well controlled. After 12-month therapy, a complete disappearance of the pituitary tumor was observed, and the hormonal evaluation confirmed the complete biochemical remission of acromegaly. Lanreotide ATG treatment was withdrawn. The clinical, biochemical, and radiological remission of acromegaly was maintained 24 months after lanreotide ATG treatment discontinuation, without evidence of disease recurrence.ConclusionsThis report represents an exemplary case of the potentiality of treatment with lanreotide ATG in inducing a complete remission of acromegalic disease, persistent after a long period of time from treatment withdrawal.

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Giant GH-secreting pituitary adenomas: management of rare and aggressive pituitary tumors

Acta Endocrinologica ◽

10.1530/eje-14-1117 ◽

2015 ◽

Vol 172 (6) ◽

pp. 707-713 ◽

Cited By ~ 23

Author(s):

Ilan Shimon ◽

Raquel S Jallad ◽

Maria Fleseriu ◽

Chris G Yedinak ◽

Yona Greenman ◽

...

Keyword(s):

Somatostatin Analogs ◽

Pituitary Tumors ◽

Pituitary Surgery ◽

Response To Treatment ◽

Visual Field Defects ◽

Cavernous Sinus Invasion ◽

Maximal Diameter ◽

Biochemical Remission ◽

Lost To Follow Up

ObjectivesPatients with acromegaly usually harbor macroadenomas measuring between 10 and 30 mm in maximal diameter. Giant (adenoma size ≥40 mm) GH-secreting pituitary tumors are rarely encountered and the aim of this study is to analyze different methods for managing them.Design and methodsWe have identified 34 patients (15 men and 19 females) with giant adenomas among 762 subjects (4.5%) with acromegaly in our records, and characterized their clinical characteristics and response to treatment.ResultsMean age at diagnosis was 34.9±12.5 years (range, 16–67 years). Mean adenoma size was 49.4±9.4 mm (range, 40–80 mm); 30 adenomas showed cavernous sinus invasion and 32 had suprasellar extension. Twenty-nine (85%) patients had visual field defects. Mean baseline IGF1 was 3.4±1.8×ULN. All patients except one underwent pituitary surgery (one to three procedures), but none achieved hormonal remission following first surgery. Among the 28 subjects with visual disturbances, 14 recovered post-operatively and 13 improved. Treatment with somatostatin analogs was given to all patients after surgical failure. Six achieved remission, nine others were partially controlled (IGF1<1.5×ULN; 3/9 when combined with cabergoline), and 17 did not respond (two were lost). Nine patients were treated with pegvisomant, alone (n=4) or in combination with somatostatin analogs (n=5); five are in remission and two are partially controlled. Pasireotide-LAR achieved hormonal remission in one of the six patients. Currently, after a mean follow-up period of 8.9 years, 17 patients are in biochemical remission, eight are partially controlled, and seven are uncontrolled (two were lost to follow-up).ConclusionsGiant GH-secreting adenomas are invasive, uncontrolled by surgery, and respond poorly to medical treatment. Aggressive multimodal therapy is critical for their management, enhancing control rate and biochemical remission.

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Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal

Acta Endocrinologica ◽

10.1530/eje-07-0488 ◽

2008 ◽

Vol 158 (1) ◽

pp. 19-25 ◽

Cited By ~ 33

Author(s):

Cristina L Ronchi ◽

Erica Rizzo ◽

Andrea G Lania ◽

Rosario Pivonello ◽

Silvia Grottoli ◽

...

Keyword(s):

Preliminary Data ◽

De Novo ◽

Somatostatin Analogs ◽

Clinical Signs ◽

Disease Recurrence ◽

Prolonged Treatment ◽

Drug Discontinuation ◽

Diabetic Patients ◽

Disease Remission ◽

Igf I

ObjectiveIt is still unknown whether prolonged treatment with somatostatin analogs (SSTa) may cause a long-lasting disease remission in GH-secreting adenomas after drug discontinuation. The aim of the present study was to investigate the evolution of GH/IGF-I secretion and tumor mass after SSTa withdrawal in patients affected by acromegaly.Patients and DesignA total of 27 patients with acromegaly (12 de novo and 15 previously operated) were treated with SSTa for a median period of 48 months and considered optimally controlled in hormonal and neuroradiological terms. None of them were previously irradiated.MethodsBasal GH, post-glucose GH nadir, IGF-I, clinical signs/symptoms, and metabolic parameters were evaluated after 12–16 weeks from drug withdrawal. Only patients who met the current criteria for disease remission remained in drug suspension being periodically re-evaluated for biochemical/clinical data and neuroradiological imaging.ResultsAfter 12–16 weeks withdrawal, 15 of the 27 patients had disease relapse and restarted SSTa, while 12 were considered ‘in disease remission’ (44% of total). Glucose metabolism improved in both euglycemic and diabetic patients after short-term SSTa discontinuation. Only one of the ten patients who reached 24 weeks withdrawal showed biochemical disease recurrence. On the whole, five of the patients still in remission after 6 months have already prolonged the follow-up over 12 months (median: 24 months), without clinical and biochemical/neuroradiological evidence of disease recurrence.ConclusionsThese preliminary data indicate a successful withdrawal of SSTa at least in a subset of well-responsive patients with acromegaly and challenge the previously held concept that medical therapy is always a lifelong requirement.

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An Introductory Examination of Speech Disfluencies in Spanish–English Bilingual Children Who Do and Do Not Stutter During Narratives

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00040 ◽

2020 ◽

Vol 5 (1) ◽

pp. 131-141

Author(s):

Cristina Rincon ◽

Kia Noelle Johnson ◽

Courtney Byrd

Keyword(s):

Diagnostic Criteria ◽

Preliminary Data ◽

Diagnostic Information ◽

English Speakers ◽

Bilingual Children ◽

English Bilingual ◽

Developmental Stuttering ◽

Mean Length Of Utterance

Purpose The purpose of this study is to examine the frequency and type of speech disfluencies (stuttering-like and nonstuttering-like) in bilingual Spanish–English (SE) children who stutter (CWS) to SE children who do not stutter (CWNS) during narrative samples elicited in Spanish and English to provide further diagnostic information for this population and preliminary data toward an expansion of this study. Method Participants included six bilingual SE children (three CWS, three CWNS) ranging in age from 5 years to 7;5 (years;months) and recruited from the surrounding Houston, Texas area. Participants provided a narrative sample in English and Spanish. The frequency of speech disfluencies was tabulated, and mean length of utterance was measured for each sample. Results Results indicate that both talker groups exceed the diagnostic criteria typically used for developmental stuttering. Regardless of the language being spoken, CWS participants had a frequency of stuttering-like speech disfluencies that met or exceeded the diagnostic criteria for developmental stuttering that is based on monolingual English speakers. The CWNS participants varied in meeting the criteria depending on the language being spoken, with one of the three CWNS exceeding the criteria in both languages and one exceeding the criteria for percentage of stuttering-like speech disfluencies in one language. Conclusion Findings from this study contribute to the development of more appropriate diagnostic criteria for bilingual SE-speaking children to aid in the reduction of misdiagnoses of stuttering in this population.

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