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This Article Accepted manuscript (PDF) All Versions of this Article: EJE-08-0498v1 159/5/525    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Petersenn, S. Articles by Ploeckinger, U. PubMed PubMed Citation Articles by Petersenn, S. Articles by Ploeckinger, U.

Results of surgical and somatostatin analogue therapy and their combination in acromegaly - a retrospective analysis of the German Acromegaly Register

S Petersenn, Division of Endocrinology, Medical Center, University of Duisburg-Essen, Essen, 45122, Germany
M Buchfelder, Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen, Germany
M Reincke, Klinikum Innenstadt, University of Munich, Munich, Germany
C Strasburger, Clinical Endocrinology CCM, Charite Universitaetsmedizin Berlin, Berlin, Germany
H Franz, Lohmann and Birkner, Health Care Consulting GmbH, Berlin, Germany
R Lohmann, Lohmann and Birkner, Health Care Consulting GmbH, Berlin, Germany
H Quabbe, Prof. emer., Charite-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, United Kingdom
U Ploeckinger, Interdisziplinaeres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charite-Universitaetsmedizin Berlin, Berlin, Germany

Correspondence: Stephan Petersenn, Email: stephan.petersenn{at}uni-due.de

Abstract

Background: Data on surgical and medical treatment outcome in acromegaly mostly originate from specialized centres. We retrospectively analysed data on surgery, primary somatostatin analogue therapy (SSA), surgery preceded by SSA and SSA preceded by surgery in 1485 patients from the German Acromegaly Register. Methods: Two trained nurses visited all centres (N=42) for data acquisition. Results: Primary surgery: Of 889 patients 554 yielded analyzable data (microadenomas 22.9%, macroadenoms 77.1%). GH and IGF-I normalized in 54.3 and 67.2%. Partial or total pituitary insufficiency occurred in 28.6% initially and 41.2% post surgery. Primary SSA (3 months): Of 329 patients 145 yielded analyzable data (microadenomas 26.7%, macroadenoms 73.3%). GH and IGF-I normalized in 36.3 and 30.5%, increasing to 40.8 and 41.5% with longer SSA (360 days) in 54 patients. Pituitary function did not change. SSA (3 months) prior to surgery: Of 234 patients 93 yielded analyzable data. Post-surgery GH and IGF-I was normalized in 62.9 and 68.4%, significantly more often compared to primary surgery for GH (p<0.05), but not for IGF-I. Surgery followed by SSA: Of 122 patients 34 yielded analyzable data. GH and IGF-I normalized during SSA in 24.1 and 45.5%., Relative GH decrease was significantly larger compared to primary SSA. Conclusions: Pituitary surgery was more effective to lower GH and IGF-I concentrations than primary SSA. Primary SSA may be an option in selected patients. SSA prior to surgery only marginally improved surgical outcome. Debulking surgery may result in better final outcome in patients with a high GH concentration and a large tumor.