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
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 3343 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 794 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 12.2183.3, median 19.6 vs post-operatively 3.152.6, 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.