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Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly

Abstract : PurposeTo determine whether pre-surgical medical treatment (PSMT) using long-acting Somatostatin analogues in acromegaly may improve long-term surgical outcome and to determine decision making criteria.MethodsThis retrospective study included 110 consecutive patients newly diagnosed with acromegaly, who underwent surgery in a reference center (Marseille, France). The mean long-term follow-up period was 51.436.5 (median 39.4) months. Sixty-four patients received PSMT during 3-18 (median 5) months before pituitary surgery. Remission was defined at early (3 months) evaluation and at last follow-up by GH nadir after oral glucose tolerance test<0.4 mu g/L and normal IGF-1.ResultsPretreated and non-pretreated groups were comparable for the main confounding factors except for higher IGF-1at diagnosis in PSMT patients. Remission rates were significantly different in pretreated or not pretreated groups (61.1% vs. 36.6%, respectively at long-term evaluation). In multivariate analysis, PSMT was significantly linked to 3 months (p<0.01) and long-term remission (p<0.01). Duration of PSMT was not significantly different in cured or non-cured patients, at both evaluation times. PSMT appeared to be more beneficial for patients with an invasive tumor. No patient with a tumor greater than 18mm or mean GH level exceeding 35ng/mL at diagnosis was cured by surgery alone (vs. 8 and 9 patients in the pretreated group, respectively). Patients with PSMT showed more transient mild hyponatremia after surgery.Conclusions p id=Par4 PSMT significantly improved short and long-term remission in patients with acromegaly, independent of its duration, especially in invasive adenomas.
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https://hal-amu.archives-ouvertes.fr/hal-01991338
Contributor : Valérie Gall <>
Submitted on : Wednesday, January 23, 2019 - 6:00:27 PM
Last modification on : Wednesday, August 19, 2020 - 12:08:21 PM

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  • HAL Id : hal-01991338, version 1

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F. Albarel, Frederic Castinetti, I. Morange, N. Guibert, Thomas Graillon, et al.. Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly. Pituitary, 2018, 21 (6), pp.615-623. ⟨hal-01991338⟩

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