Effects of initial therapy for five years with somatostatin analogs for acromegaly on growth hormone and insulin-like growth factor-I levels, tumor shrinkage, and cardiovascular disease: a prospective study.

Abstract

OBJECTIVE:

The objective of the study was to evaluate the efficacy of 5 yr of depot somatostatin analogs (SSAs) as first-line therapy in acromegaly.

OUTCOME MEASURES:

Primary measures were fasting GH 2.5 microg/liter or less and IGF-I normalized for age and tumor shrinkage. Secondary measures were control of hypertension, arrhythmias, left ventricular hypertrophy, diastolic and systolic dysfunction, and change in lipid and glucose profile.

PATIENTS:

Patients included 45 de novo patients (18 women and 27 men, aged 20-82 yr); 28 were treated with octreotide-long-acting release and 17 with lanreotide.

RESULTS:

GH was controlled in 100% and IGF-I levels in 97.8%, tumor shrinkage was 74.9 +/- 22.1 and 78.2+/-14.5%, in the octreotide-long-acting release and lanreotide groups, respectively. There was a significant improvement in the prevalence of hypertension (from 46.7 to 22.2%, P = 0.027), arrhythmias (from 17.8% to zero, P = 0.01), left ventricular hypertrophy (from 82.2 to 42.2%, P < 0.0001), diastolic dysfunction (from 60.0 to 15.6%, P < 0.0001), systolic dysfunction (from 40.0 to 4.4%, P < 0.0001), and hypertriglyceridemia (from 40.0 to 4.4%, P < 0.0001). The prevalence of impaired glucose tolerance (IGT; from 28.9 to 20.0%. P = 0.46) and diabetes mellitus (from 22.4 to 31.1%, P = 0.64) did not change.

CONCLUSIONS:

In patients with severe comorbidities and those who refuse surgery, 5 yr of exclusive SSA therapy induce successful control of GH and IGF-I; tumor shrinkage (by median 80%), and improvement of hypertension, cardiac performance; and dyslipidemia. No patient was withdrawn from treatment because of side effects, and glucose tolerance was stable. We suggest that first-line SSA treatment may be safely continued in patients with acromegaly, according to an individual patient's indications and preferences.

• Authors: Annamaria Colao, Renata S Auriemma, Mariano Galdiero, Gaetano Lombardi, Rosario Pivonello
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 94 Issue 10 Pg. 3746-56 (Oct 2009) ISSN: 1945-7197 [Electronic] United States
• PMID: 19622615 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents, Hormonal
• Delayed-Action Preparations
• Peptides, Cyclic
• lanreotide
• Human Growth Hormone
• Somatostatin
• Insulin-Like Growth Factor I
• Octreotide

Topics

• Acromegaly (blood, drug therapy, etiology)
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Hormonal (therapeutic use)
• Contraindications
• Delayed-Action Preparations
• Female
• Human Growth Hormone (blood)
• Humans
• Insulin-Like Growth Factor I (metabolism)
• Male
• Middle Aged
• Neurosurgical Procedures
• Octreotide (therapeutic use)
• Peptides, Cyclic (therapeutic use)
• Pituitary Neoplasms (complications, drug therapy)
• Prospective Studies
• Risk Factors
• Somatostatin (analogs & derivatives, therapeutic use)
• Treatment Outcome