Endocrine Abstracts

Aim: The aim of multi-center, observational study was to assess the outcome of the treatment with somatostatin analogue octreotide-LAR (O-LAR) patients with acromegaly.

Material: Material consisted of 360 patients (60% women) aged 18–84 years (mean 45.5; S.D.±12.9) with active acromegaly. Prior to the inclusion 172 patients underwent unsuccessful neurosurgery.

Methods: Observation was planned for 1 year. O-LAR monthly dose was adjusted to 10–30 mg accordingly to IGF-1 levels. Assessments of clinical symptoms and GH/IGF-1 was performed quarterly. Visual field and pituitary MR was performed initially, and after 12 months.

Results: Observation completed 330 patients from 29 centers in Poland, mainly from Warsaw (84), Poznań (51) and Silesian region (45). Mean period of symptomatic disease prior to diagnosis was 8.8 years (1–24 S.D.±4.9). Concomitant diseases was hypertension (64.2%), diabetes mellitus (20.3%) and heart failure (8.3%). Goiter was present in 59.2% and hyperthyroidism in 8.6% cases. Prior to O-LAR treatment pituitary macroadenoma was shown in 62%. Initially, mean GH concentration was 19.5 μg/l (S.D. ±35; 1.0–449 μg/l) and decreased significantly during treatment to 8.4 μg/l (S.D.±11.5) after 3 months, and finally to 5.6 μg/l (S.D. ±7.9), P<0.0001. Parallelly, mean IGF-1 concentration was 894.5 μg/l (S.D. ±350; 209–2461 μg/l) and decreased to 573.5 μg/l (S.D.±311) (P<0.001), and finally to 457 μg/l (S.D.±262) (P<0.001). IGF-1 normalization was achieved in 61.6% patients. Pituitary tumor volume decreased significantly (>25%) in 57% of patients. Treatment led to significant reduction of acromegaly symptoms: soft tissues edema was present initially in 95%, after treatment – in 47%, hyperhydrosis in 90 and 42%, respectively, headaches 80–49%, arthralgia 85–55%, weakness 69–43%, carpal tunnel syndrome 18–4%, paresthesiae 43–39%, sleep apnoea 19–8%, galactorrhoea 6–1%. Adverse effects were mild and mainly affected gastrointestinal system (diarrhea in 15% and during treatment fell to 5%, abdominal pain 8% fell to 4%, and nausea affected 8% and fell to 5%. No therapy discontinuation occurred. This is the largest observational study to assess O-LAR efficacy in acromegaly reported. Results proves, high efficacy of medical therapy with somatostatin analogue in terms of clinical and biochemical improvement. Therapy is safe and well-tolerated.