Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal.

Abstract

OBJECTIVE:

It is still unknown whether prolonged treatment with somatostatin analogs (SSTa) may cause a long-lasting disease remission in GH-secreting adenomas after drug discontinuation. The aim of the present study was to investigate the evolution of GH/IGF-I secretion and tumor mass after SSTa withdrawal in patients affected by acromegaly.

PATIENTS AND DESIGN:

A total of 27 patients with acromegaly (12 de novo and 15 previously operated) were treated with SSTa for a median period of 48 months and considered optimally controlled in hormonal and neuroradiological terms. None of them were previously irradiated.

METHODS:

Basal GH, post-glucose GH nadir, IGF-I, clinical signs/symptoms, and metabolic parameters were evaluated after 12-16 weeks from drug withdrawal. Only patients who met the current criteria for disease remission remained in drug suspension being periodically re-evaluated for biochemical/clinical data and neuroradiological imaging.

RESULTS:

After 12-16 weeks withdrawal, 15 of the 27 patients had disease relapse and restarted SSTa, while 12 were considered 'in disease remission' (44% of total). Glucose metabolism improved in both euglycemic and diabetic patients after short-term SSTa discontinuation. Only one of the ten patients who reached 24 weeks withdrawal showed biochemical disease recurrence. On the whole, five of the patients still in remission after 6 months have already prolonged the follow-up over 12 months (median: 24 months), without clinical and biochemical/neuroradiological evidence of disease recurrence.

CONCLUSIONS:

These preliminary data indicate a successful withdrawal of SSTa at least in a subset of well-responsive patients with acromegaly and challenge the previously held concept that medical therapy is always a lifelong requirement.

• Authors: Cristina L Ronchi, Erica Rizzo, Andrea G Lania, Rosario Pivonello, Silvia Grottoli, Annamaria Colao, Ezio Ghigo, Anna Spada, Maura Arosio, Paolo Beck-Peccoz
• Journal: European journal of endocrinology (Eur J Endocrinol) Vol. 158 Issue 1 Pg. 19-25 (Jan 2008) ISSN: 1479-683X [Electronic] England
• PMID: 18166813 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hormones
• Human Growth Hormone
• Somatostatin
• Insulin-Like Growth Factor I

Topics

• Acromegaly (drug therapy, metabolism)
• Adult
• Aged
• Blood Glucose (metabolism)
• Female
• Follow-Up Studies
• Glucose Tolerance Test
• Glycated Hemoglobin (metabolism)
• Hormones (therapeutic use)
• Human Growth Hormone (blood)
• Humans
• Insulin-Like Growth Factor I (metabolism)
• Male
• Middle Aged
• Somatostatin (analogs & derivatives, therapeutic use)
• Time Factors