Endocrine Abstracts

We enrolled 30 acromegalics from 2005.4 to 2007.7 at endocrine outpatient clinic of four academic hospitals. Male to female ratio was equal (15/15). Unsuppressed GH confirmed 28 out of 30 patients with oral glucose tolerance test. Average serum GH level was 28.7 ng/ml, and average IGF-I, 985 ng/ml. Micro- to macroadenoma was 8/22 (26%). Before treatment, 28 out of 30 acromegalics were taken 100 μg of somatostatin suppression test, complete responder (GH was suppressed below 1 ng/ml) was 39% (11/28), lower IGF-I (879±322 vs 1035±403 ng/ml) and most of them (6/7, 86%) were microadenoma. Biochemical cure rate after surgery was assessed with suppressed GH after oGTT below 1 n/ml, macroadenoma revealed 67% (8/12) and 100% (5/5) in microadenoma. Paradoxical response of GH to TRH (18/30) was observed in 78% (14/18) of acromegalics. Overall cure rate with trans-sphenoidal adenoidectomy (TSA) was 80% (16/19). All 3 microadenomas were removed completely.

On focusing to 12 acromegalics, preoperative use of octreotide-LAR (median duration, 12 weeks) showed complete removal of tumors regardless of tumor size (macro:micro=9:3). Tumor volume, hormone profiles before and after use of octreotide-LAR showed in Table 1. The preoperative use of Octreotide-LAR could achieve complete removal of pituitary tumors and biochemical cure of acromegaly. But, in a surgical point of view, sergeons encountered many problems during operation. Because newly developed severe fibrosis between normal and shrunken tumor tissue due to preoperative use of octreotide-LAR regardless of its duration should make operation too hard to more shrink arachnoid space, more chance to CSF leak. These findings suggested that how surgeon’s skill was important. In conclusion, preoperative use of octreotide-LAR might be predicted improvement of surgical outcome via reduction of tumor volume, but severe fibrosis should be a critical obstacle to easy removal of tumors and more chance to get operative complication as CSF leakage.