Stratégies thérapeutiques dans les adénomes somatotropes avec extension extrasellaire. Place du traitement médical. Etude consensus du Répertoire français de l'Acromégalie.
[en] From the first 198 patient files included into the French Acromegaly Registry, we analyzed 68 patients harboring a somatotroph adenoma with extrasellar extension, after exclusion of those treated by stereotactic or conventional radiotherapy. In these patients (including 37 women), aged 21-77 yr. (45.7 +/- 13.3), GH concentrations ranged from 2-260 microg/L (38.6 +/- 44.3), and IGF I from 86-967% of age-matched upper limit of normal (303 +/- 164). Maximal diameter of the adenoma at MRI was 11-36.5 mm (20.4 +/- 6.5), with cavernous sinus involvement in 68% of cases. Three subgroups were defined: 20 patients treated by long-acting somatostatin analogs only (group M), for a mean duration of 3 yr. (extremes 1-7 yr.), 48 patients initially treated by transsphenoidal surgery (group C), of whom 21 were secondarily treated by long-acting somatostatin analogs (group CM) for a mean duration of 1.2 yr. (extremes 0.2-2 yr.). All 3 groups were not statistically different in terms of tumor mass and initial levels of GH and IGF-1. Patients from group M were significantly older than those of the other groups (p<0.05). RESULTS: 46% of patients from group C after surgery vs. 45% of patients from group M had a mean GH below 2.5 microg/L. Biochemical remission (GH<2.5 microg/L and normal IGF1 normal) was obtained in 31% of cases in group C, vs. 25% in group M. In this group, a decrease of the largest tumor diameter was observed in 10 patients (71.5%), ranging from 10-25% in 7 (50%) and exceeded 50% in 3 (21.5%). In group CM, the biochemical remission rate (42%) and final GH or IGF1 values were not significantly different from group M. In conclusion, these data suggest that surgery or long-acting somatostatin analogs have a comparable efficacy in terms of remission rates in somatotroph macroadenomas with extrasellar extensions. [fr] À partir des 198 premiers dossiers enregistrés dans le Registre Français de l'Acromégalie, 68 patients porteurs de macroadénomes somatotropes avec extension extrasellaire ont été analysés, après exclusion des cas ayant bénéficié d'une radiothérapie conventionnelle ou stéréotaxique. Chez ces sujets (dont 37 femmes), âgés de 21 à 77 ans (45,7 ± 13,3 ans), les concentrations de GH variaient de 2 à 260 pg/L (38,6 ± 44,3). L'IGF I variait de 86 à 967 % de la limite supérieure pour l'âge (303 ± 164). Le diamètre maximal de l'adénome sur l'IRM variait de 11 à 36,5 mm (20,4 ± 6,5), avec atteinte d'au moins un sinus caverneux dans 68 % des cas. Trois sous-groupes ont été définis: 20 patients traités exclusivement par analogues retard de la somatostatine (groupe M), pendant une durée moyenne de 3 ans (extrêmes 1-7 ans), 48 patients traités initialement par chirurgie transphénoïdale (groupe C), dont 21 traités, en seconde intention, par les analogues retard de la somatostatine (groupe CM) pendant une durée moyenne de 1,2 ans (extrêmes 0,2-2 ans). Les 3 groupes étaient comparables en termes de masse tumorale et de niveau initial de GH et d'IGF-I. Les patients du groupe M étaient significativement plus âgés que les patients des 2 autres groupes (p < 0,05). Résultats: 46 % des patients du groupe C après chirurgie et 45 % des patients du groupe M présentaient une valeur moyenne de GH inférieure à 2,5 μg/L. La rémission biologique (GH < 2,5 μg/L et IGF1 normal) était obtenue dans 31 % des cas dans le groupe C, contre 25 % dans le groupe M. Dans ce groupe, une diminution du plus grand diamètre tumoral était observée chez 10 patients (71,5 %), comprise entre 10 % et 25 % pour 7 d'entre eux (50 %) et supérieure à 50 % pour trois des patients (21,5 %). Dans le groupe CM, le taux de rémission biologique (42 %) et les valeurs finales de GH et IGF1 n'étaient pas significativement différentes de ceux du groupe M. En conclusion, ces données suggèrent une efficacité comparable, en termes de pourcentage de rémission, du traitement chirurgical et du traitement par analogues de la somatostatine dans les macroadénomes somatotropes avec extension extrasellaire.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Jaquet, Ph
Cortet-Rudelli, Ch
Sassolas, G.
Morange-Ramos, I.
Chanson, Philippe
Brue, Th
Andrieu, J. M.
Beckers, Albert ; Université de Liège - ULiège > Département des sciences cliniques > Endocrinologie
Bertherat, J.
Borson-Chazot, F.
Brassier, G.
Caron, Ph
Cogne, M.
Cottier, JPh
Delemer, B.
Dufour, H.
Enjalbert, A.
Figarella-Branger, D.
Gaillard, R.
Gueydan, M.
Janssens, Marc ; Université de Liège - ULiège > Anesthésie et réanimation
Stratégies thérapeutiques dans les adénomes somatotropes avec extension extrasellaire. Place du traitement médical. Etude consensus du Répertoire français de l'Acromégalie.
Alternative titles :
[en] Therapeutic strategies in somatotroph adenomas with extrasellar extension: role of the medical approach, a consensus study of the French Acromegaly Registry
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