Direct postoperative and follow-up results of transsphenoidal surgery in 19 acromegalic patients pretreated with octreotide compared to those in untreated matched controls

In this study 19 patients were preoperatively treated with octreotide for 1 -17 months (mean, 5 months), with doses from 150-1500 mu g daily, and those patients were matched to 19 untreated patients with comparable tumor class ification and preoperative serum GH concentrations. Octreotide was started at 300 mu g daily by sc injections or continuous sc infusion using a pump i n increasing doses, depending on the responses of the serum GH and insulin- libe growth factor I (IGF-I) concentrations. During pretreatment, seven pat ients achieved a serum GH concentration below 5 mU/L, whereas six patients normalized their serum IGF-I. Postoperatively, a serum GH concentration below 5 mU/L was achieved in 15 p retreated and 14 untreated patients, a normal serum IGF-I level (<2 SD) was achieved in 10 pretreated and 15 untreated patients, and normal serum GH s uppression during GTT was reached in 12 treated and 14 control patients. No differences were found in complication rate or incidence of hypopituitaris m caused by surgery. Adjuvant therapy was required in 7 treated and 5 untreated patients. At fol low-up examination, 5.7 and 4 yr postoperatively, 10 pretreated and 12 cont rol patients could be considered cured by surgery only, according to our cr iteria for remission (serum GH, <5 mU/L; normal GH suppression and normal s erum IGF-I). In summary, we found no difference in direct postoperative and follow-up results of transsphenoidal surgery between pretreated patients a nd untreated patients. This finding is in discordance with other studies, w hich have claimed a beneficial effect of octreotide pretreatment.