• Annamaria Colao, Roberto Attanasio, Rosario Pivonello, Paolo Cappabianca, Luigi M Cavallo, Giovanni Lasio, Alessandro Lodrini, Gaetano Lombardi, and Renato Cozzi.
• Department of Molecular and Clinical Endocrinology and Oncology, Federico II University of Naples, via S. Pansini 5, 80131 Naples, Italy. colao@unina.it
• J. Clin. Endocrinol. Metab. 2006 Jan 1; 91 (1): 85-92.

ContextSurgery is a cornerstone in the treatment of acromegaly, but its efficacy in large, invasive tumors is scant.ObjectiveThe objective of this study was to investigate whether partial surgical removal of GH-secreting pituitary tumors enhances the response rate to somatostatin analogs (SSA; sc octreotide, slow-release octreotide, and lanreotide).DesignThis was a multicenter, open, retrospective study.SettingThe study was performed at university hospitals.Subjects And MethodsEighty-six patients (42 women and 44 men; age, 42 +/- 14 yr) with acromegaly were studied.InterventionsPatients underwent two courses of octreotide, lanreotide, or slow-release octreotide treatments before and after surgery of at least 6 months.Main Outcome MeasureThe main outcome measure was normal IGF-I levels for age.ResultsPresurgical SSA treatment significantly decreased GH and IGF-I levels in all patients. GH levels were less than 2.5 microg/liter in 12 patients (14%); IGF-I levels normalized in nine (10%). After surgery, GH and IGF-I levels further decreased in all patients; tumor removal was greater than 75% in 50 (58%), 50.1-75% in 21 (24%), 25.1-50% in 10 (12%), and less than 25% in five patients (6%). Preoperatively, pituitary function was impaired in 12 patients (14%). Postsurgical SSA treatment lowered GH levels to less than 2.5 microg/liter in 49 (56%) and normalized IGF-I levels in 48 patients (55%). The success rate was significantly increased compared with that before surgery (P < 0.0001). GH (r = -0.48; P < 0.0001) and IGF-I levels (r = -0.38; P = 0.0003) after postsurgery SSA treatment correlated with the amount of tumor surgically removed. After surgery, pituitary function was impaired in 28 patients (32.6%) and was improved in 12 patients (13.9%). The cumulative prevalence of pituitary deficiency did not change during the study (normal function from 40 to 42%; deficiency from 60 to 58%).ConclusionsSurgical tumor removal (>75%) enhances the response to SSAs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.

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