Somatotrope pituitary adenomas. Contribution of presurgical treatment withsomatostatin analogs

Presurgical treatment of somatotrope pituitary adenomas with somatostatin a nalogs is warranted by the efficacy of both octreotide and lanreotide in th e treatment of acromegaly. This efficacy is expressed in terms of symptom r elief, reduced growth hormone secretion, lower IGF-1 levels. and reduced tu mor volume. Excepting encased microadenomas and macroademonmas, all patients with acrom egaly should be given somatostatin analogs preoperatively. In addition, in certain cases of microadenomas, it may be advisable to postpone surgery whi le giving this medical treatment. The following protocol can be used. subcutaneous octreotide to initiate tre atment in order to progressively increase dosage and minimize secondary dig estive tract side effects, followed by long acting formulations for 3 month s. Treatment is assessed on clinical secretory efficacy and radiology chang es in tumor volume as well as tolerance taking into account for the excepti onal cases of pancreatic or hepatic disturbances. In our own personal experience, preoperative treatment almost always improv e symptomatology, reduces hormone levels in 70 % of the cases and reduces t umor volume in all patients, by more than 30 % in 20 % of patients. ils dem onstrated by the body of published work on presurgical rise of somatostatin analogs, dris treatment improves post-surgery outcome. This treatment is a lso cost-effective.