Sub-acute tumour debulking with somatostatin analogues in newly diagnosed acromegaly due to macroadenomas
Cristina Olarescu1,4, Øystein Husby1, Ansgar Heck1, Geir Ringstad2, Jon Terje Ramm-Pettersen3, Anders Palmstrøm Jørgensen1 & Jens Bollerslev1
Background: Surgery is accepted as first line treatment of somatotroph macroadenomas with involvement of the optic chiasm. However, during recent years somatostatin analogues (SA) have increasingly been used as primary treatment improving ultimate cure rate, as SAs have anti-proliferative effects in most tumours. We demonstrate here positive effect of subacute/acute SA treatment on tumour shrinkage and chiasm decompression in two recently diagnosed acromegalic patients.
Patients and results: Two female patients (P1 and P2) with newly diagnosed acromegaly due to GH secreting macroadenomas are presented. Both tumours were invasive, unable to be cured by direct surgery, and were compressing the optic chiasm. Ophthalmologic examination revealed slight temporal and nasal visual field defects but without vision affection. Both responded extensively on octreotide test (50 μg): GH decreased from 64.7 to 1.8 mUI/l (96%), (P1) and from >120 to 37 mUI/l, (P2). Both patients were treated primarily with subcutaneous SA, under very close follow up.
P1 was treated with 3×50 μg octreotide/day (for 15 days) and P2 received first 3×50 μg octreotide/day (for 4 days) then 3×100 μg octreotide/day (for 8 days). The table shows patients pre-treatment and post-treatment characteristics.
Discussion and conclusion: We present selected cases of newly diagnosed acromegaly with slight visual field defects, impractical to be cured by direct surgery. Both were successfully treated primarily with SAs under close and careful follow-up, followed by significant tumor volume reduction and consequently relieve of the optic chiasm. We suggest that SA treatment is a possibility in selected cases for sub-acute debulking.