Journal of Clinical Endocrinology & Metabolism, Vol 79, 1416-1423, Copyright © 1994 by Endocrine Society

ARTICLES

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

U Plockinger, M Reichel, U Fett, W Saeger and HJ Quabbe
Department of Endocrinology, Klinikum Steglitz, Freie Universitat, Berlin, Germany.

The factors that determine the hormone and volume responses of pituitary adenomas to the somatostatin analog octreotide are poorly understood. We, therefore, studied the correlation between 111indium- pentetreotide somatostatin receptor scintigraphy (SRS) and the clinical and immunohistochemical classification of pituitary adenomas, on the one hand, and hormone and volume responses, on the other hand. Ten patients with GH-secreting (6 females and 4 males; age, 31-67 yr) and 14 patients with clinically nonfunctioning (NF) macroadenomas (5 females and 9 males; age, 22-79 yr) were preoperatively treated with 300 micrograms/day octreotide, which was increased to 600 and 1500 micrograms/day at weekly intervals and then continued for at least 3 months until surgery. SRS was performed before therapy. A sellar magnetic resonance imaging scan was performed before therapy; 1, 2, and 3 weeks and 3 months after start of therapy; and after surgery. Acromegalics also had an 8-h GH profile, insulin-like growth factor-I determination, and a 100-g oral glucose load at these time points. An attempt was made to identify NF adenomas as gonadotroph adenomas using their LH, FSH, and alpha-subunit responses to TRH. In acromegalic patients, octreotide suppressed mean GH (8-h profile) and insulin-like growth factor-I concentrations from 34.9 +/- 9.7 to 8.1 +/- 3.6 micrograms/L and from 2122 +/- 1025 to 701 +/- 208 micrograms/L, respectively, after 3 months. Significant (26-85% decline) tumor shrinkage occurred in 5 of 10 patients, mainly within the first week. Tumor shrinkage and GH suppression were not correlated. Four of 7 patients had increased pituitary 111indium-pentetreotide uptake, but this did not predict GH suppression or tumor shrinkage. Of the NF adenomas, 2 responded with shrinkage (57% and 96% decline). Four of 12 adenomas had increased 111indium-pentetreotide uptake, but this did not correlate with tumor shrinkage (2 adenomas; 1 gonadotroph and 1 null cell adenoma), immunohistochemistry, or clinical classification. We conclude that preoperative octreotide therapy suppresses GH in most patients and reduces tumor volume in up to 50% of acromegalic patients. It also induces shrinkage in some NF adenomas, although less frequently. SRS does not predict shrinkage of either tumor type. Shrinkage does not correlate with clinical classification or immunohistological characteristics. Further studies are needed to identify the factors that determine the hormone and volume responses of pituitary adenomas to octreotide therapy.

This article has been cited by other articles:

				T. Florio, F. Barbieri, R. Spaziante, G. Zona, L. J Hofland, P. M van Koetsveld, R. A Feelders, G. K Stalla, M. Theodoropoulou, M. D Culler, et al. Efficacy of a dopamine-somatostatin chimeric molecule, BIM-23A760, in the control of cell growth from primary cultures of human non-functioning pituitary adenomas: a multi-center study Endocr. Relat. Cancer, June 1, 2008; 15(2): 583 - 596. [Abstract] [Full Text] [PDF]

				G. F Taboada, R. M Luque, W. Bastos, R. F C Guimaraes, J. B Marcondes, L. M C Chimelli, R. Fontes, P. J P Mata, P. N. Filho, D. P Carvalho, et al. Quantitative analysis of somatostatin receptor subtype (SSTR1-5) gene expression levels in somatotropinomas and non-functioning pituitary adenomas Eur. J. Endocrinol., January 1, 2007; 156(1): 65 - 74. [Abstract] [Full Text] [PDF]

				D. O'Toole, A. Saveanu, A. Couvelard, G. Gunz, A. Enjalbert, P. Jaquet, P. Ruszniewski, and A. Barlier The analysis of quantitative expression of somatostatin and dopamine receptors in gastro-entero-pancreatic tumours opens new therapeutic strategies Eur. J. Endocrinol., December 1, 2006; 155(6): 849 - 857. [Abstract] [Full Text] [PDF]

				A. Colao, R. Pivonello, R. S. Auriemma, F. Briganti, M. Galdiero, F. Tortora, F. Caranci, S. Cirillo, and G. Lombardi Predictors of Tumor Shrinkage after Primary Therapy with Somatostatin Analogs in Acromegaly: A Prospective Study in 99 Patients J. Clin. Endocrinol. Metab., June 1, 2006; 91(6): 2112 - 2118. [Abstract] [Full Text] [PDF]

				S. Melmed, R. Sternberg, D. Cook, A. Klibanski, P. Chanson, V. Bonert, M. L. Vance, D. Rhew, D. Kleinberg, and A. Barkan A Critical Analysis of Pituitary Tumor Shrinkage during Primary Medical Therapy in Acromegaly J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 4405 - 4410. [Abstract] [Full Text] [PDF]

				D. Vezzosi, A. Bennet, P. Rochaix, F. Courbon, J. Selves, B. Pradere, L. Buscail, C. Susini, and P. Caron Octreotide in insulinoma patients: efficacy on hypoglycemia, relationships with Octreoscan scintigraphy and immunostaining with anti-sst2A and anti-sst5 antibodies Eur. J. Endocrinol., May 1, 2005; 152(5): 757 - 767. [Abstract] [Full Text] [PDF]

				J. S. Bevan The Antitumoral Effects of Somatostatin Analog Therapy in Acromegaly J. Clin. Endocrinol. Metab., March 1, 2005; 90(3): 1856 - 1863. [Abstract] [Full Text] [PDF]

				A. Ben-Shlomo and S. Melmed The Role of Pharmacotherapy in Perioperative Management of Patients with Acromegaly J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 963 - 968. [Full Text] [PDF]

				N. R. Biermasz, H. van Dulken, and F. Roelfsema Direct Postoperative and Follow-Up Results of Transsphenoidal Surgery in 19 Acromegalic Patients Pretreated with Octreotide Compared to Those in Untreated Matched Controls J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3551 - 3555. [Abstract] [Full Text] [PDF]

				D. Ferone, S. Lastoria, A. Colao, P. Varrella, G. Cerbone, W. Acampa, B. Merola, M. Salvatore, and G. Lombardi Correlation of Scintigraphic Results Using 123I-Methoxybenzamide with Hormone Levels and Tumor Size Response to Quinagolide in Patients with Pituitary Adenomas J. Clin. Endocrinol. Metab., January 1, 1998; 83(1): 248 - 252. [Abstract] [Full Text]

				A. Colao, D. Ferone, P. Cappabianca, M. L. del Basso De Caro, P. Marzullo, A. Monticelli, A. Alfieri, B. Merola, A. CalI, E. de Divitiis, et al. Effect of Octreotide Pretreatment on Surgical Outcome in Acromegaly J. Clin. Endocrinol. Metab., October 1, 1997; 82(10): 3308 - 3314. [Abstract] [Full Text] [PDF]

				R. J. Robbins Depot Somatostatin Analogs--A New First Line Therapy for Acromegaly J. Clin. Endocrinol. Metab., January 1, 1997; 82(1): 15 - 17. [Full Text] [PDF]