Disappearance of a GH Secreting Macroadenoma, during Long-term Somatostatin Analogue Administration

Abstract

Acromegaly is caused by excessive growth hormone secretion, usually from a pituitary adenoma. Increased mortality rate is reverted to that of the normal population after decreasing GH and IGF-I levels to less than 2–2.5 μg/liter and normal sex- and age-matched controls, respectively, regardless of the treatment employed. The use of somatostatin analogues as primary or adjunctive therapy has been widely applied in the management of acromegaly. A few cases have been reported in the literature, complete shrinkage of a pituitary GH secreting macroadenoma after long-term somatostatin analogue administration. We report a patient in whom long term (60 months) octreotide-L.A.R administration resulted in complete disappearance of a growth hormone secreting pituitary macroadenoma.

Key words

acromegaly - adenoma - disappearance - pituitary - somatostatin analogue

References

• 1 Swearingen B, Barker  2nd  FG, Katznelson L. et al . Long-term mortality after transsphenoidal surgery and adjunctive therapy for acromegaly.  J Clin Endocrinol Metab. 1998;  83 ((10)) 3419-3426
• 2 Bates AS, Van’t Hoff W, Jones JM. et al . An audit of outcome of treatment in acromegaly.  Q J Med. 1993;  86 ((5)) 293-299
• 3 Biermasz NR, Dulken H van, Roelfsema F. Ten-year follow-up results of transsphenoidal microsurgery in acromegaly.  J Clin Endocrinol Metab. 2000;  85 ((12)) 4596-4602
• 4 Beauregard C, Truong U, Hardy J. et al . Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly.  Clin Endocrinol (Oxf). 2003;  58 ((1)) 86-91
• 5 Melmed S, Casanueva FF, Cavagnini F. et al . For the acromegaly treatment consensus workshop participants guidelines for acromegaly management.  J Clin Endocrinol Metab. 2002;  87 4054-4058
• 6 Newman CB, Melmed S, George A. et al . Octreotide as primary treatment for acromegaly.  J Clin Endocrinol Metab. 1998;  83 3034-3040
• 7 Culler MD. Evolving concepts in the quest for advanced therapeutic analogues of somatostatin.  Dig Liver Dis. 2004;  36 S17-S25
• 8 Kaltsas GA, Stefanidou Z, Papadogias D. et al . Treatment of advanced neuroendocrine tumours with the radiolabelled somatostatin analogue octreotide.  Hormones. 2002;  1 149-156
• 9 Krassas G, Pontikides N, Dumas A. et al . The effect of long-term somatostatin analogue treatment on free and total insulin-like growth factor (IGF) -I, -II, and IGF binding protein -1, -2, and -3 serum levels in euthyroid patients with active thyroid eye disease.  Hormones. 2004;  3 191-197
• 10 Orme SM, Lamb JT, Nelson M. et al . Shrinkage of thyrotrophin secreting pituitary adenoma treated with octreotide.  Postgrad Med. 1991;  J67 466-468
• 11 Williams G, Ball J, Bloom S. et al . Improvement in headache associated with prolactinoma during treatment with a somatostatin analogue: an “N of 1” study.  N Engl J Med. 1986;  315 1166-1167
• 12 Pugnale N, Waridel F, Bouzourene H. et al . Pharyngeal pituitary non-functioning adenoma with normal intra-sellar gland: massive tumor shrinkage on octreotide therapy.  Eur J Endocrinol. 2003;  148 357-364
• 13 Colao A, Lombardi G. Growth hormone and prolactin excess.  Lancet. 1998;  352 1455-1461
• 14 Freda PU, Wardlaw SL, Post KD. Long-term endocrinological follow-up evaluation in 115 patients who underwent transsphenoidal surgery for acromegaly.  J Neurosurg. 1998;  89 353-358
• 15 Kaltsas GA, Isidori AM, Florakis D. et al . Predictors of the outcome of surgical treatment in acromegaly and the value of the mean growth hormone day curve in assessing postoperative disease activity.  J Clin Endocrinol Metab. 2001;  86 1645-1652
• 16 Newman CB, Melmed S, George A. et al . Octreotide as primary therapy for acromegaly.  J Clin Endocrinol Metab. 1998;  83 3034-3040
• 17 Hofland LJ, Lamberts SW. The pathophysiological consequences of somatostatin receptor internalization and resistance.  Endocr Rev. 2003;  24 28-47
• 18 Park C, Yang I, Woo . et al . Somatostatin (SRIF) receptor subtype 2 and 5 gene expression in growth hormone-secreting pituitary adenomas: The relationship with endogenous SRIF activity and response to octreotide.  Endocr. 2004;  J 51 227-236
• 19 Lundin P, Eden Engstrom B, Karlsson FA. et al . Long-term octreotide therapy in growth hormone-secreting pituitary adenomas: evaluation with serial MR.  Am J Neuroradiol. 1997;  18 765-772
• 20 Newman CB, Melmed S, Snyder PJ. et al . Safety and efficacy of long-term octreotide therapy of acromegaly: results of a multicenter trial in 103 patients – a clinical research center study.  J Clin Endocrinol Metab. 1995;  80 2768-2775
• 21 Colao A, Ferone D, Marzullo P. et al . Long-term effects of depot long-acting somatostatin analog octreotide on hormone levels and tumor mass in acromegaly.  J Clin Endocrinol Metab. 2001;  86 2779-2786
• 22 Plockinger U, Reichel M, Fett U. et al . Preoperative octreotide treatment of growth hormone-secreting and clinically nonfunctioning pituitary macroadenomas: effect on tumor volume and lack of correlation with immunohistochemistry and somatostatin receptor scintigraphy.  J Clin Endocrinol Metab. 1994;  79 1416-1423
• 23 Freda PU, Katznelson L, Lely AJ van der. et al . Long-acting somatostatin analog therapy of acromegaly: a meta-analysis.  J Clin Endocrinol Metab. 2005;  90 4465-4473
• 24 Lucas T, Astorga R, Catala M. Preoperative lanreotide treatment for GH-secreting pituitary adenomas: effect on tumour volume and predictive factors of significant tumour shrinkage.  Clin Endocrinol. 2003;  58 471-481
• 25 Bevan JS, Atkin SL, Atkinson AB. et al . Primary medical therapy for acromegaly: an open, prospective, multicenter study of the effects of subcutaneous and intramuscular slow-release octreotide on growth hormone, insulin-like growth factor-I, and tumor size.  J Clin Endocrinol Metab. 2002;  87 4554-4563
• 26 Resmini E, Murialdo G, Giusti M. et al . Pituitary tumor disappearance in a patient with newly diagnosed acromegaly primarily treated with octreotide LAR.  J Endocrinol Invest. 2005;  28 ((2)) 166-169
• 27 Livadas S, Hadjidakis DJ, Argyropoulou MI. et al . Disappearance of a growth hormone secreting macro adenoma during long-term somatostatin analogue administration and recurrence following somatostatin withdrawal.  Hormones (Athens). 2006;  5 ((1)) 57-63
• 28 Harinarayan CV. Primary octreotide LAR therapy in GH-secreting pituitary adenoma.  J Indian Med Assoc (abstract). 2004;  102 ((5)) 258-260-1
• 29 Barkan AL, Lloyd RV, Chandler WF. et al . Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: shrinkage of invasive pituitary macroadenomas and improved surgical remission rate.  J Clin Endocrinol Metab. 1988;  67 1040-1048
• 30 Ezzat S, Kontogeorgos G, Redelmeier DA. et al . In vivo responsiveness of morphological variants of growth hormone-producing pituitary adenomas to octreotide.  Eur J Endocrinol. 1995;  133 686-690
• 31 Thapar K, Kovacs KT, Stefaneanu L. et al . Antiproliferative effect of the somatostatin analogue octreotide on growth hormone-producing pituitary tumors: results of a multicenter randomized trial.  Mayo Clin Proc. 1997;  72 893-900

Correspondence