acromegalic patients; octreotide subcutaneously; transsphenoidal surgery
Abstract :
[en] Twenty-four acromegalic patients were treated with octreotide subcutaneously for periods of 3 to 6 weeks (group I, 12 cases) or 6 months (group II, 12 cases) before transsphenoidal surgery. Radiological studies performed in 19 patients before and at the end of this treatment period revealed no changes in 8 cases. In 8 other cases, a slight reduction in tumorsize was observed, and in 3 cases an important shrinkage was documented. At surgery, the adenomatous tissue appeared softer than in nonpretreated patients, facilitating the operation. Pathological examination revealed widening of perivascular spaces with accumulation of fibrous tissue and more crinophagy than in nonpretreated patients but failed to reveal morphologically pronounced cell involution as observed in prolactin-producing adenomas treated with dopamine agonists. No significant difference in frequency or extent of cellular changes was noted between the two groups. These morphological findings seem to be more consistent with a functional inhibition of growth hormone release than with cellular alterations induced by octreotide.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Beckers, Albert ; Université de Liège - ULiège > Département des sciences cliniques > Endocrinologie
Kovacs, K.
Horvwarth, E.
Abs, R.
Reznik, Michel ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Asa S.L., Scheithauer B.W., Bilbao J.M., Horvath E., Ryan N., Kovacs K., Randall R.V., Laws E.R., Singer W., Linfoot J.A., Thorner M.O., Vale W. (1984) A case for hypothalamic acromegaly: a clinical study of six patients with hypothalamic gangliocytomas producing growth hormone-releasing factor. J Clin Endocrinol Metab 58:796-803.
Barkan A.L., Kelch R.P., Hopwood N.J., Beitins I.Z. (1988) Treatment of acromegaly with the longacting somatostatin analog SMS 201-995. J Clin Endocrinol Metab 66:16-23.
Barkan A.L., Lloyd R.V., Chandler W.F., Hatfield M.K., Gebarski S.S., Kelch R.P., Beitins I.Z. (1988) Preoperative treatment of acromegaly with long-acting somatostatin analog SMS 201-995: shrinkage of invasive pituitary macroadenomas and improved surgical remission rate. J Clin Endocrinol Metab 67:1040-1048.
Barnard L.B., Grantham W.G., Lamberton P., O’Dorisio T.M., Jackson I.M. (1986) Treatment of resistant acromegaly with long-acting somatostatin analogue (SMS 201-995). Ann Intern Med 105:856-861.
Bauer W., Briner U., Doepfner W., Haller R., Huguenin R., Marbach P., Petcher T.J., Press J. (1983) SMS 201-995: a very potent and selective octapeptide analogue of somatostatin with prolonged action. Life Sci 31:1133-1140.
Besser G.M., Mortimer C.H., Carr D., Schally A.V., Coy D.H., Evered D., Kastin A.J., Turnbridge W.M.G., Thorner M.O., Hall R. (1974) Growth hormone release inhibiting hormone in acromegaly. Br Med J 1:352-355.
Chiodini P.G., Cozzi R., Dallabonzana D., Oppizzi G., Verde G., Petroncini M., Liuzzi A., del Pozo E. (1987) Medical treatment of acromegaly with SMS 201-995, a somatostatin analog: a comparison with bromocriptine. J Clin Endocrinol Metab 64:447-453.
Comi R.J., Gorden P. (1987) The response of serum growth hormone levels to the long-acting somatostatin analog SMS 201-995 in acromegaly. J Clin Endocrinol Metab 64:37-42.
Ducasse M.C.R., Tauber J.P., Tourre A., Bonafe A., Babin T.H., Tauber M.T., Harris A.G., Bayard F. (1987) Shrinking of a growth hormone-producing pituitary tumor by continuous subcutaneous infusion of the somatostatin analog SMS 201-995. J Clin Endocrinol Metab 65:1042-1046.
George S.R., Kovacs K., Asa S.L., Horvath E., Cross E.G., Burrow G.N. (1987) Effect of SMS 201-995, a long acting somatostatin analogue, on the secretion and morphology of a pituitary growth hormone cell adenoma. Clin Endocrinol (Oxf) 26:395-405.
Guiot G., Oproiu A., Hertzog E., Fredy D. (1969) Adénomes hypophysaires. EMC Paris 17:340.
Kovacs K., Horvath E. (1986) Tumors of the pituitary gland. Atlas of tumor pathology, second series, fascicle 21 , Armed Forces Institute of Pathology, Washington, DC; 1-269.
Lamberts S.W.J., Oosterom R., Neufeld M., del Pozo E. (1985) The somatostatin analog SMS 201-995 induces long-acting inhibition of growth hormone secretion without rebound hypersecretion in acromegalic patients. J Clin Endocrinol Metab 60:1161-1165.
Lamberts S.W.J., Uitterlinden P., Verschoor L., Van Dongen K.J., del Pozo E. (1985) Longterm treatment of acromegaly with the somatostatin analogue SMS 202–995. N Engl J Med 313:1576-1580.
Lamberts S.W.J., Zweens M., Verschoor L., del Pozo E. (1986) A comparison among the growth hormone-lowering effects in acromegaly of the somatostatin analog SMS 201-995, bromocriptine and the combination of both drugs. J Clin Endocrinol Metab 3:16-19.
Landolt A.M., Osterwalder V. (1984) Perivascular fibrosis in prolactinomas: is it increased by bromocriptine?. J Clin Endocrinol Metab 8:1179-1183.
Landolt A.M., Osterwalder V., Stuckrnann G. (1987) Preoperative treatment of acromegaly with SMS 201–995: surgical and pathological observation. Growth hormone, growth factors and acromegaly , D.K., Ludecks, G., Tolis, Raven Press, New York; 229-244.
Scheithauer B.W., Kovacs K., Randall R.V., Horvath E., Okazaki H., Laws (1983) Hypothalamic neuronal hamartoma and adenohypophyseal neuronal choristoma: their association with growth hormone adenoma of the pituitary. J Neuropathol Exp Neurol 2:648-663.
Spinas G.A., Zapf J., Landolt A.M., Stuckmann G., Froesch E.R. (1987) Preoperative treatment of 5 acromegalics with somatostatin analogue: endocrine and clinical observations. Acta Endocrinol (Copenh) 14:249-256.
Sternberger L.A., Hardy P.H., Cuculis J., Meyer H.G. (1970) The unlabeled antibody enzyme method of immunochemistry. Preparation and properties of soluble antigen-antibody complex (horseradish peroxydase anti-horseradish peroxidase) and its use in the identification of spirochetes. J Histochem Cytochem 8:315-333.
Tindall G.T., Kovacs K., Horvath E., Thorner M.O. (1982) Human prolactin-producing adenomas and bromocriptine: a histological, immunocytochemical, ultrastructural, and morphometric study. J Clin Endocrinol Metab 5:1178-1183.
Vezina J.L., Maltais R. (1973) La selle turcique dans l’acromégalie. Etude radiologiquc. Neurochir-urgic 9:35.