Endocrine Abstracts (2006) 11 P548

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

1Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, United Kingdom; 2Department of Neuroradiology, Radcliffe Infirmary, Oxford, United Kingdom; 3Department of Endocrinology, Christie Hospital, Manchester, United Kingdom.

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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