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Departments of Molecular and Clinical Endocrinology and Oncology and Neurological Sciences, Section of Neurosurgery (P.C., L.M.C.), University Federico II (A.C., R.P., G.L.), 80131 Naples, Italy; Division of Endocrinology, Hospital Niguarda Ca Granda (R.A., R.C.), 20162 Milan, Italy; and Division of Neurosurgery, Neurologic Institute Carlo Besta (G.L., A.L.), 20162 Milan, Italy
Address all correspondence and requests for reprints to: Dr. Annamaria Colao, Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via S. Pansini 5, 80131 Naples, Italy. E-mail: colao{at}unina.it.
Context: Surgery is a cornerstone in the treatment of acromegaly, but its efficacy in large, invasive tumors is scant.
Objective: The objective of this study was to investigate whether partial surgical removal of GH-secreting pituitary tumors enhances the response rate to somatostatin analogs (SSA; sc octreotide, slow-release octreotide, and lanreotide).
Design: This was a multicenter, open, retrospective study.
Setting: The study was performed at university hospitals.
Subjects and Methods: Eighty-six patients (42 women and 44 men; age, 42 ± 14 yr) with acromegaly were studied.
Interventions: Patients underwent two courses of octreotide, lanreotide, or slow-release octreotide treatments before and after surgery of at least 6 months.
Main Outcome Measure: The main outcome measure was normal IGF-I levels for age.
Results: Presurgical SSA treatment significantly decreased GH and IGF-I levels in all patients. GH levels were less than 2.5 µg/liter in 12 patients (14%); IGF-I levels normalized in nine (10%). After surgery, GH and IGF-I levels further decreased in all patients; tumor removal was greater than 75% in 50 (58%), 50.1–75% in 21 (24%), 25.1–50% in 10 (12%), and less than 25% in five patients (6%). Preoperatively, pituitary function was impaired in 12 patients (14%). Postsurgical SSA treatment lowered GH levels to less than 2.5 µg/liter in 49 (56%) and normalized IGF-I levels in 48 patients (55%). The success rate was significantly increased compared with that before surgery (P < 0.0001). GH (r = –0.48; P < 0.0001) and IGF-I levels (r = –0.38; P = 0.0003) after postsurgery SSA treatment correlated with the amount of tumor surgically removed. After surgery, pituitary function was impaired in 28 patients (32.6%) and was improved in 12 patients (13.9%). The cumulative prevalence of pituitary deficiency did not change during the study (normal function from 40 to 42%; deficiency from 60 to 58%).
Conclusions: Surgical tumor removal (>75%) enhances the response to SSAs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.
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