ISSN 1470-3947 (print)
ISSN 1479-6848 (online)

Searchable abstracts of presentations at key conferences in endocrinology

Published by BioScientifica
Endocrine Abstracts (2006) 11 P548 
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Surgical debulking of GH secreting adenomas improves control of acromegaly by lanreotide – a prospective study

JAH Wass1, V Fazal-Sanderson1, J Byrne2, S Rowel3, N Karavitaki1, P Trainer3 & HE Turner1

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It has been suggested that primary medical treatment of patients with acromegaly using somatostatin analogues (SSA) is as effective at controlling GH levels as post-operative SSA therapy.

We have carried out a prospective study in patients harbouring GH secreting macroadenomas to see, in a within-patient comparison, whether debulking pituitary surgery improved GH control on lanreotide compared with that obtained pre-operatively. Local Ethical Committee approval was obtained.

We studied 27 patients (11 males) with acromegaly and macroadenomas treated with lanreotide for 4 months. At week 8, if necessary (mean GH>5 mU/l), the dose was titrated up to obtain maximal GH suppression. Four months post-operatively the patients were re-evaluated and, if not cured, were treated with lanreotide, as pre-operatively.

Before commencing on lanreotide, mean GH ranged from 3–343 mU/l (median 59.2). On lanreotide 9/27 subjects (33%) suppressed mean GH to <5 mU/l. Post-operatively 21/27 patients (77.8%) had mean GH<5 mU/l. Six had persistently abnormal GH secretion (mean GH 7–94 mU/l, median 35). Re-treatment with lanreotide resulted in lower GH values than those obtained pre-operatively with lanreotide in all six subjects (pre-operatively 12.2–183.3, median 19.6 vs post-operatively 3.1–52.6, median 6.4, P<0.01). In 3 out of these 6 patients (50%), lanreotide post-operatively resulted in mean GH<5 mU/l, which was not the case in any of them while on lanreotide pre-operatively.

In this first prospective study using lanreotide pre- and post-operatively, we show that surgical debulking of GH secreting macroadenomas, even if not curative, improves response to SSA therapy and the combined therapy (SSA+surgery) improves cure rates.

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