Introduction: In Mexico there is scant literature about medical management and its response in patients with acromegaly. Octreotide LAR at a dosage of 20 mg weekly is considered as first line treatment in patients who failed to surgery or who are not candidates to surgical treatment. The goal of this initial dosage is to reach GH levels below 1.0 ng/ml and insuline like factor type 1 (IGF1) levels within range for age and gender. The objective of this study is to determine the percentage of patients that attain goals for GH and IGF1 after 36 doses of Octreoride LAR.
Methods: We included patients with acromegaly diagnosis within our centre, between the years 1995 and 2015 that received a minimum of three applications of Octreotide LAR before obtaining new levels of GH and IGF1 to determine response to treatment. We included patients that received surgical treatment before institution of Octreotide and those who had contraindications to surgery and had to initiate Octreotide as part of initial treatment.
Results: A total of 34 patients were included, with an average of five applications of Octreotide LAR before evaluation, 67% had surgical treatment, 68% were male, with an age average of 47 years, 20% had diabetes, and 38% had systemic hypertension. Initial GH levels were 8.19 ng/ml in average and with an average tumour diameter of 15 mm. In all patients a decrease in GH and IGF1 levels was observed (3.65 ng/ml in average), but only 15% attained GH and IGF1 levels goals, 50% continued with active disease and the rest had a discordant pattern. Among patients that received surgical treatment prior to Octreotide LAR only 8% attained goals, 52% remained active. Of the patients who did not receive surgery 27% attained goals and 46% remained active.
Conclusion: Despite a decrease in GH and IGF1 levels in all patients after Octreotide LAR treatment only 15% attained goals. Patients who did not received surgery had better results than patients who received it. This initial mode of treatment is not enough to control disease so over 70% of patients will need higher doses of Octreotide LAR and perhaps association with other drugs.
20 - 23 May 2017
European Society of Endocrinology