Presurgical Octreotide Treatment in Acromegaly

The effects of octreotide pretreatment before surgery were assessed in 48 acromegalic patients who underwent trans-sphenoidal surgery to remove pituitary adenoma, and compared with 107 patients who did not receive octreotide before surgery. Pretreated patients received octreotide 100 micrograms, thrice daily for 3 to 6 weeks (group 1), or 100 to 500 micrograms, thrice daily for 3 to 39 months (group 2). Total remission of symptoms was seen in 54%. Partial remission of symptoms occurred in 39%. Octreotide pretreatment reduced plasma GH levels by > or = 50% in all patients. GH levels were reduced to < 2 micrograms/1 in 3/14 group 1 cases and 13/34 group 2 cases. Tumour shrinkage occurred in 56.5% of patients. Marked tumour shrinkage (> 25%) occurred in more group 2 patients (10/32 vs 1/14). The tumour was soft in 39 patients, firm in 6 and hard in 3 cases. Soft consistency aided surgical removal of adenomas. Remission was greater in enclosed adenomas than in invasive tumours in both octreotide pretreated and nonpretreated acromegalics (76 vs 30%). Remission was more likely if the adenoma was less than 16 mm. Remission rate was significantly greater (p < 0.05) in all octreotide pretreated than in untreated patients for enclosed adenoma, but not for invasive adenoma. Octretide pretreatment can be recommended for three to four months prior to surgery.