help button home button Endocrine Society JCEM JCEM Call for Nominations for EIC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a related Letter to the Editor
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Copyright Permission
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bevan, J. S.
Right arrow Articles by Wardlaw, J. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bevan, J. S.
Right arrow Articles by Wardlaw, J. M.
The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 10 4554-4563
Copyright © 2002 by The Endocrine Society

Original Article

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. S. Bevan, S. L. Atkin, A. B. Atkinson, P.-M. Bouloux, F. Hanna, P. E. Harris, R. A. James, M. McConnell, G. A. Roberts, M. F. Scanlon, P. M. Stewart, E. Teasdale, H. E. Turner, J. A. H. Wass and J. M. Wardlaw

Department of Endocrinology, Aberdeen Royal Infirmary (J.S.B.), Aberdeen, United Kingdom AB25 2ZN; Department of Endocrinology, Hull Royal Infirmary (S.L.A.), Hull, United Kingdom HU3 3KZ; Department of Endocrinology, Royal Victoria Hospital (A.B.A., M.M.), Belfast, United Kingdom BT12 6BA; Department of Endocrinology, Royal Free Hospital (P.-M.B.), London, United Kingdom NW3 2QQ; Department of Endocrinology, University Hospital of Wales (F.H., M.F.S.), Cardiff, United Kingdom CF4 4XN; Department of Endocrinology, Kings’ College Hospital (P.E.H., G.A.R.), London, United Kingdom SE5 9RS; Department of Endocrinology, Royal Victoria Infirmary (R.A.J.), Newcastle-upon-Tyne, United Kingdom NE1 4LP; Department of Endocrinology, Queen Elizabeth Hospital (P.M.S.), Birmingham, United Kingdom B15 2TH; Department of Endocrinology, Radcliffe Infirmary (H.E.T., J.A.H.W.), Oxford, United Kingdom OX2 6HE; Department of Neuroradiology, Southern General Hospital (E.T.), Glasgow, United Kingdom G51 4TF; and Department of Neuroradiology, Western General Hospital (J.M.W.), Edinburgh, United Kingdom EH4 2XU

Address all correspondence and requests for reprints to: J. S. Bevan, M.D., F.R.C.P., Department of Endocrinology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom AB25 2ZN. E-mail: j.s.bevan{at}arh.grampian.scot.nhs.uk.

Abstract

Conventional surgery and radiotherapy for acromegaly have limitations. There are few data on the use of the somatostatin analog octreotide (Oct) as primary medical therapy. An open prospective study of 27 patients with newly diagnosed acromegaly was conducted in nine endocrine centers in the United Kingdom. Twenty patients had macroadenomas, and 7 had microadenomas. For the first 24 wk (phase 1), patients received sc Oct in an initial dose of 100 µg, 3 times daily, increased to 200 µg three times daily after 4 wk in the 13 patients whose mean serum GH remained greater than 5 mU/liter (2 µg/liter). Five-point GH profiles were performed at 0, 4, 12, and 24 wk, and high resolution pituitary imaging using a standard protocol was performed at 0, 12, and 24 wk (magnetic resonance imaging in 25 patients and computed tomography in 2). Tumor dimensions and volumes were calculated by a central, reporting neuroradiologist, and the results were audited by a second, independent neuroradiologist. After 24 wk, 15 patients proceeded to phase 2 of the study with a direct switch to monthly injections of the depot formulation of Oct, Sandostatin long-acting release (Oct-LAR). Further GH profiles were performed at 36 and 48 wk, and pituitary imaging was performed at 48 wk.

The median pretreatment serum GH concentration was 30.7 mU/liter (range, 6.7–141.4). During sc Oct, serum GH fell to less than 5 mU/liter in 9 patients (38%), and IGF-I fell to normal in 8 patients (33%). All 27 tumors shrank during sc Oct; for microadenomas the median tumor volume reduction was 49% (range, 12–73), and for macroadenomas it was 43% (range, 6–92). After 24 wk of Oct-LAR (end of phase 2), the GH level was less than 5 mU/liter in 11 of 14 patients (79%), and IGF-I was normal in 8 of 15 patients (53%). In the 15 patients given Oct-LAR (10 macroadenomas), wk 48 scans showed a further overall median tumor volume reduction of 24%. At the end of the study 79% of patients had mean serum GH levels below 5 mU/liter, 53% had normal IGF-I levels, and 73% showed greater than 30% tumor shrinkage. Twenty-nine percent of patients achieved all 3 targets, but no patient with pretreatment GH levels above 50 mU/liter did so at any stage of the study.

Primary medical therapy with Oct offers the prospect of normalization of GH/IGF-I levels together with substantial tumor shrinkage in a significant subset of acromegalic patients. This is most likely to occur in patients with pretreatment GH levels less than 50 mU/liter (20 µg/liter).




This article has been cited by other articles:


Home page
 Eur J EndocrinolHome page
J. van der Hoek, S. W J Lamberts, and L. J Hofland
Preclinical and clinical experiences with the role of somatostatin receptors in the treatment of pituitary adenomas
Eur. J. Endocrinol., April 1, 2007; 156(suppl_1): S45 - S51.
[Abstract] [Full Text] [PDF]

Home page
 Ann OncolHome page
C Susini and L Buscail
Rationale for the use of somatostatin analogs as antitumor agents
Ann. Onc., December 1, 2006; 17(12): 1733 - 1742.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
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]

Home page
 J. Clin. Endocrinol. Metab.Home page
R. Cozzi, M. Montini, R. Attanasio, M. Albizzi, G. Lasio, S. Lodrini, P. Doneda, L. Cortesi, and G. Pagani
Primary Treatment of Acromegaly with Octreotide LAR: A Long-Term (Up to Nine Years) Prospective Study of Its Efficacy in the Control of Disease Activity and Tumor Shrinkage
J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1397 - 1403.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
A. Colao, R. Pivonello, R. S Auriemma, M. C. De Martino, M. Bidlingmaier, F. Briganti, F. Tortora, P. Burman, I. A Kourides, C. J Strasburger, et al.
Efficacy of 12-month treatment with the GH receptor antagonist pegvisomant in patients with acromegaly resistant to long-term, high-dose somatostatin analog treatment: effect on IGF-I levels, tumor mass, hypertension and glucose tolerance.
Eur. J. Endocrinol., March 1, 2006; 154(3): 467 - 477.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
A. Pokrajac, A. G Claridge, S K A. Shakoor, and P. J Trainer
The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly
Eur. J. Endocrinol., February 1, 2006; 154(2): 267 - 274.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
C. L. Ronchi, V. Varca, P. Beck-Peccoz, E. Orsi, F. Donadio, A. Baccarelli, C. Giavoli, E. Ferrante, A. Lania, A. Spada, et al.
Comparison between Six-Year Therapy with Long-Acting Somatostatin Analogs and Successful Surgery in Acromegaly: Effects on Cardiovascular Risk Factors
J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 121 - 128.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
J Ayuk and M C Sheppard
Growth hormone and its disorders
Postgrad. Med. J., January 1, 2006; 82(963): 24 - 30.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. Bhayana, G. L. Booth, S. L. Asa, K. Kovacs, and S. Ezzat
The Implication of Somatotroph Adenoma Phenotype to Somatostatin Analog Responsiveness in Acromegaly
J. Clin. Endocrinol. Metab., November 1, 2005; 90(11): 6290 - 6295.
[Abstract] [Full Text] [PDF]

Home page
 Journal of the American Animal Hospital AssociationHome page
C. A. Hurty and B. Flatland
Feline Acromegaly: A Review of the Syndrome
J. Am. Anim. Hosp. Assoc., September 1, 2005; 41(5): 292 - 297.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
G M Besser, P Burman, and A F Daly
Predictors and rates of treatment-resistant tumor growth in acromegaly
Eur. J. Endocrinol., August 1, 2005; 153(2): 187 - 193.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
M Rix, P Laurberg, A S Hoejberg, and B Brock-Jacobsen
Pegvisomant therapy in pituitary gigantism: successful treatment in a 12-year-old girl
Eur. J. Endocrinol., August 1, 2005; 153(2): 195 - 201.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
R. Fahlbusch, B. v Keller, O. Ganslandt, J. Kreutzer, and C. Nimsky
Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging
Eur. J. Endocrinol., August 1, 2005; 153(2): 239 - 248.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
P. U. Freda, L. Katznelson, A. J. van der Lely, C. M. Reyes, S. Zhao, and D. Rabinowitz
Long-Acting Somatostatin Analog Therapy of Acromegaly: A Meta-Analysis
J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4465 - 4473.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
W. W de Herder, H R. Taal, P. Uitterlinden, R. A Feelders, J. A M J L Janssen, and A.-J. van der Lely
Limited predictive value of an acute test with subcutaneous octreotide for long-term IGF-I normalization with Sandostatin LAR in acromegaly
Eur. J. Endocrinol., July 1, 2005; 153(1): 67 - 71.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
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]

Home page
 Eur J EndocrinolHome page
J. Wass
Debulking of pituitary adenomas improves hormonal control of acromegaly by somatostatin analogues
Eur. J. Endocrinol., May 1, 2005; 152(5): 693 - 694.
[Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
D. Selvarajah, J. Webster, R. Ross, and J. Newell-Price
Effectiveness of adding dopamine agonist therapy to long-acting somatostatin analogues in the management of acromegaly
Eur. J. Endocrinol., April 1, 2005; 152(4): 569 - 574.
[Abstract] [Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
P. Nomikos, M. Buchfelder, and R. Fahlbusch
The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'
Eur. J. Endocrinol., March 1, 2005; 152(3): 379 - 387.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
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]

Home page
 Eur J EndocrinolHome page
I. E Bonapart, R. van Domburg, S. M T H ten Have, W. W de Herder, R. A M Erdman, J. A M J L Janssen, and A. J. van der Lely
The 'bio-assay' quality of life might be a better marker of disease activity in acromegalic patients than serum total IGF-I concentrations
Eur. J. Endocrinol., February 1, 2005; 152(2): 217 - 224.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
J. Ayuk, R. N. Clayton, G. Holder, M. C. Sheppard, P. M. Stewart, and A. S. Bates
Growth Hormone and Pituitary Radiotherapy, But Not Serum Insulin-Like Growth Factor-I Concentrations, Predict Excess Mortality in Patients with Acromegaly
J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1613 - 1617.
[Abstract] [Full Text] [PDF]

Home page
 Endocr. Rev.Home page
A. Colao, D. Ferone, P. Marzullo, and G. Lombardi
Systemic Complications of Acromegaly: Epidemiology, Pathogenesis, and Management
Endocr. Rev., February 1, 2004; 25(1): 102 - 152.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
J. van der Hoek, W. W. de Herder, R. A. Feelders, A.-J. van der Lely, P. Uitterlinden, V. Boerlin, C. Bruns, K. W. Poon, I. Lewis, G. Weckbecker, et al.
A Single-Dose Comparison of the Acute Effects between the New Somatostatin Analog SOM230 and Octreotide in Acromegalic Patients
J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 638 - 645.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
R. Attanasio, R. Baldelli, R. Pivonello, S. Grottoli, L. Bocca, V. Gasco, M. Giusti, G. Tamburrano, A. Colao, and R. Cozzi
Lanreotide 60 mg, a New Long-Acting Formulation: Effectiveness in the Chronic Treatment of Acromegaly
J. Clin. Endocrinol. Metab., November 1, 2003; 88(11): 5258 - 5265.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
D. R. Clemmons, K. Chihara, P. U. Freda, K. K. Y. Ho, A. Klibanski, S. Melmed, S. M. Shalet, C. J. Strasburger, P. J. Trainer, and M. O. Thorner
Optimizing Control of Acromegaly: Integrating a Growth Hormone Receptor Antagonist into the Treatment Algorithm
J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4759 - 4767.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S.-G. Ren, J. Taylor, J. Dong, R. Yu, M. D. Culler, and S. Melmed
Functional Association of Somatostatin Receptor Subtypes 2 and 5 in Inhibiting Human Growth Hormone Secretion
J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4239 - 4245.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
R. Cozzi, R. Attanasio, M. Montini, G. Pagani, G. Lasio, S. Lodrini, M. Barausse, M. Albizzi, D. Dallabonzana, and A. M. Pedroncelli
Four-Year Treatment with Octreotide-Long-Acting Repeatable in 110 Acromegalic Patients: Predictive Value of Short-Term Results?
J. Clin. Endocrinol. Metab., July 1, 2003; 88(7): 3090 - 3098.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
Z Merza
Modern treatment of acromegaly
Postgrad. Med. J., April 1, 2003; 79(930): 189 - 194.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Endocrinology Endocrine Reviews J. Clin. End. & Metab.
Molecular Endocrinology Recent Prog. Horm. Res. All Endocrine Journals
Copyright © 2002 by The Endocrine Society