Long-term primary medical therapy with somatostatin analogs in acromegaly

To cure acromegalic patients, transsphenoidal surgery is considered first, especially for microadenoma. However, less than 50% of patients with macroadenoma achieve satisfactory biochemical control. Moreover, surgery may cause hypopituitarism. Medical therapy may offer the prospect of near normalization of growth hormone (GH)/insulin-like growth factor-1 levels with substantial tumor shrinkage in a significant number of patients. Here, we report two cases of acromegaly under treatment with somatostatin analogs alone for more than 10 years. Case 1 was a 54-year-old man with a pituitary macroadenoma. He received 4 years of octreotide treatment followed by 6 years of prolonged-release (PR) lanreotide resulting in normal GH level. Case 2 was a 60-year-old woman with a 1.3 cm pituitary tumor. She received 8 years of octreotide treatment followed by 6 years of PR lanreotide resulting in subnormal GH level and gallbladder sludge. She had received bilateral total hip replacement for hip osteoarthritis at the age of 59 years. These cases illustrate that long-term treatment with somatostatin analogs offers an alternative choice in selected acromegalic patients, such as those with pituitary tumor who cannot be cured by surgery, those who have unacceptable anesthetic risk and those who refuse surgery. ? 2006 Elsevier & Formosan Medical Association.Indications:2 patients with acromegaly secondary to pituitary tumor (microadenoma in 1 patient). Concomitant disease: hypertension (2).Patients:2 patients (inpatient and outpatient). Case 1: 54-year-old male patient. Case 2: 60-year-old female patient.TypeofStudy:This study described the outcome of long-term somatostatin analogs (Sandostatin and lanreotide) treatment in patients with acromegaly. 2 case reports.DosageDuration:Case 1: initially 50 mcg tid (=150 mcg daily) sc for the first 2 days and then 100 mcg tid (=300 mg daily) sc thereafter. Duration: 3 years and 4 months. Case 2: 100 mcg tid (=300 mcg daily) sc. Duration: at least 8 years.FreeText:Case 1 presented with enlarged nose, forehead, and jaw in 1993 (at age 42 years). By October 1993, acromegaly was suspected. In August 1995, he developed blurred vision in the left eye and elevated serum growth hormone (GH, 25 mcg/L) and prolactin (76.5 mcg/L) levels were noted. Magnetic resonance imaging (MRI) of the pituitary showed a tumor at the right side of the sella. Sandostatin treatment was initiated. Concomitant drugs were valsartan and indapamide. Case 2 presented with enlarged fingers in 1985 (at age 42 years). Three years later, elevated serum GH level (36 mcg/L) was noted. Computer tomography (CT) scan of the head revealed a pituitary tumor (1.3 cm in diameter) at the right side. On admission in April 1990, she showed prognathism, frontal bossing, enlarged thyroid gland, oily skin, and widely spaced teeth with malocclusion. Her hand volume was 300 ml for both hands. Tests showed elevated GH levels (56 mcg/L) and oral glucose tolerance tests revealed nonsuppressible GH levels (all more that 49 mcg/L). Skull x-ray disclosed a double contoured sella turcica. Sandostatin treatment was initiated. Concomitant drugs were antihypertensive agents.Results:In case 1, no significant side effect was observed following Sandostatin sc injection. Sandostatin treatment was begun on October 1995 and by April 1996, his serum GH levels was 4.8 mcg/L and MRI revealed a smaller pituitary tumor. His blurred vision also improved. By January 1999, his serum GH level was 2 mcg/L. In the beginning of February 1999, Sandostatin treatment was substituted by lanreotide. In case 2, no significant adverse effect was observed following Sandostatin sc injection (April 1990). In July 1990, her serum GH level decreased to 8 mcg/L. Cranial CT scan revealed a reduction in the pituitary tumor size. At the time of Sandostatin withdrawal, her serum GH level was >75 mcg/L. She continued to receive Sandostatin treatment from another hospital for 4 years and at her most recent visit, her serum GH level was 24.5 mcg/L. In March 1995, MRI showed a pituitary tumor 1.2 cm. In February 1999, prior to the start of lanreotide treatment, her serum GH level was 6-8 mcg/L.AdverseEffects:Unspecified side effects occurred.AuthorsConclusions:These cases illustrate that long-term treatment with somatostatin analogs offers an alternative choice in selected acromegalic patients, such as those with pituitary tumor who cannot be cured by surgery, those who have unacceptable anesthetic risk and those who refuse surgery.