Endocrine Abstracts

Introduction: Somatostatin analogs (SS-analogs) are the treatment option when there is a persistent disease despite surgical intervention. They can be also recommended as a first line treatment if surgery is not appropriate (non-curative or contraindicated surgery).

Objetive: To evaluate the effect of first-generation SS-analogs (lanreotide and octreotide) on tumour shrinkage and biochemical control in naive patients.

Methods: We performed a prospective study of 23 acromegalic patients (followed between years 2000 and 2015) treated with SS-analogs awaiting surgery. We evaluated mean age, associated comorbidities, growth hormone (GH), insulin growth factor 1 (IGF1), and prolactin (PRL) mean levels, also tumour volume (TV) and maximum tumour diameter (MTD) reduction, and repercussion of SS-analogs in the glicaemic metabolism; baseline and after 6 months of treatment. The differences between groups were calculated by Wilcoxon test.

Results: The mean age at diagnosis was 48±13 years, 39% men and 61% women. 87% were macroadenomas. BMI was 26±4 kg/m². Hypertension was found in 47%, glicaemic metabolism disorders in 47%, dyslipidemia in 26%, obstructive sleep apnea hypopnea syndrome in 17%, carpal tunnel syndrome in 30%. 57% of patients received high doses of SS-analogs, 34% medium doses and 9% low doses. 26% received concomitant treatment with cabergoline. After 6 months of treatment, we found significant differences in: MTD (18±9 previous vs 15±9 mm, P=0.001), TV (3098±4,829 vs 2,362±5,005 mm³, P=0.001), GH levels (30±28 vs 12±20 ng/ml, P=0.003), IGF1 levels (1182±461 vs 661±50 ng/ml, P=0.000) and PRL levels (29±33 vs 7.4±5.4 ng/ml, P=0.001). After 6 months of treatment: 26% normalized IGF1, 13% had GH levels under 1 ng/ml and 61% achieved a TV reduction ≥ 20%. We did not find significant differences in glicaemic metabolism after receiving treatment with SS-analogs (glycemia 119±37 vs 114±17 mg/dl, P=0.74 and HbA1c 6±0.9 vs 6.1±0.8%, P=0.66).

Conclusions: Our results demonstrate the clinical benefit, in biochemical control and tumour shrinkage, of SS-analogs as a primary treatment for patients with acromegaly.