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Submitted on February 8, 2008
Accepted on May 9, 2008
ivind Johannesen, Department of Laboratory Medicine, Childrens and Womens Health, Norwegian University for Science and Technology, Trondheim; Department of Endocrinology, St. Olavs Hospital, Trondheim; Department of Neurosurgery, Haukeland University Hospital, Bergen; Neurosurgery Unit, Institute of Surgical Sciences, University of Bergen, Bergen; Endocrinology Unit, Department of Medicine, Rikshospitalet-Radiumhospitalet Medical Center, Oslo; Endocrinology Unit, Department of Medicine, Haukeland University Hospital and Institute of Medicine, University of Bergen; Endocrinology Unit, Department of Medicine, Aker University Hospital, Oslo; Endocrinology Unit, Department of Medicine, University Hospital of North Norway; Institute of Clinical Medicine, University of Tromsø; Endocrinology Unit, Department of Medicine, Stavanger University Hospital, Stavanger; Department of Radiology, Rikshospitalet-Radiumhospitalet Medical Center, Oslo; and Research Institute for Internal Medicine, University of Oslo, Oslo, Norway
* To whom correspondence should be addressed. E-mail: sven.carlsen{at}ntnu.no.
Context: Surgery is the primary treatment of acromegaly. However it often fails to cure the patient. New strategies that improve surgical outcome are needed.
Objective: To investigate whether six months preoperative treatment with octreotide improves the surgical outcome in newly diagnosed acromegalic patients.
Patients: During a five year period (1999 – 2004) all newly diagnosed acromegalic patients between 18 and 80 years of age in Norway were screened and invited to participate in the study. Sixty-two patients were included in the Preoperative Octreotide Treatment of Acromegaly (POTA) study.
Research design and methods: After a baseline evaluation patients were randomized directly to transsphenoidal surgery (n=30) or to pre-treatment with octreotide (n=32) 20 mg im. every 28th day for six months prior to transsphenoidal surgery. Cure was evaluated three months postoperatively primarily by Insulin like Growth Factor-1 levels (IGF-1).
Results: According to the IGF-1 criteria 14 out of 31 (45%) pretreated patients vs. 7 out of 30 (23%) patients with direct surgery were cured by surgery (p=0.11). In patients with microadenomas (
10 mm) 1 out of 5 (20%) pretreated vs. 3 out of 5 (60%) with direct surgery were cured (p=0.52). In patients with macroadenomas 13 out of 26 (50%) pretreated vs. 4 out of 25 (16%) with direct surgery were cured (p=0.017).
Conclusion: Six months preoperative octreotide treatment might improve surgical cure rate in newly diagnosed acromegalic patients with macroadenomas. These results have to be confirmed in future studies.
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  A. Beckers Does Preoperative Somatostatin Analog Treatment Improve Surgical Cure Rates in Acromegaly? A New Look at an Old Question J. Clin. Endocrinol. Metab., August 1, 2008; 93(8): 2975 - 2977. [Full Text] [PDF]
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