Endocrine Abstracts

Context: Following the recent evolution in therapeutic strategies for GH-secreting pituitary adenomas, determining optimal individualized patient management is now crucial.

Objective: To determine whether pre-surgical medical treatment (PSMT) in patients with acromegaly improves surgical outcome and to specify thresholds for such a strategy.

Methods and design: This retrospective study included 110 newly diagnosed acromegalic patients operated on between 1997 and 2007 at Timone Hospital, Marseille, France. The mean long-term follow-up period was 52±36.6 months (median 41 months). 64 patients (58.4%) received PSMT (long acting Somatostatin Analogs) during 2–18 months (mean 6.4 months) and all patients underwent pituitary surgery. Remission was based on updated criteria, associating GH nadir after oral glucose tolerance test <0.4 μg/l and normal IGF1 for age, sex and gender at early (3 months) evaluation or at the end of follow-up (n=95).

Results: In multivariate analysis, PSMT was significantly linked to early remission (45.3% patients in remission with PSMT vs 26.1% without; P=0.01) and to long-term remission (61.1% with PSMT vs 36.6% without; P<0.01). Duration of PSMT was not significantly different in cured or non-cured patients, at both evaluations. At 3 months and at long-term evaluation, pre-treated and non pre-treated groups were comparable for the main confounding factors except for IGF1 at diagnosis which was higher in patients with PSMT. PSMT was more beneficial for patients with somatotroph adenoma larger than 15 mm. Noteworthy, no patient with a more than 18 mm adenoma or a mean GH exceeding 35 ng/ml at diagnosis was cured by surgery without PSMT.

Conclusions: Pre-surgical medical treatment significantly improved short and long-term remission in acromegalic patients, independently of its duration and main confounding factors, and seemed to be especially interesting in adenomas larger than 15 mm.