Surgical debulking of pituitary adenomas improves responsiveness to octreotide lar in the treatment of acromegaly

摘要

Abstract Background Studies comparing primary medical treatment of acromegaly with surgery are often non-randomized, and not stratified by illness severity. We prospectively compared primary medical therapy with pituitary surgery in patients with acromegaly. All patients had macroadenomas, at least one random human growth hormone (GH) level?≥12.5?ng/mL, elevated IGF-I levels and failure to suppress GH to Methods Forty-one patients from seven centers were randomized to primary treatment with octreotide LAR, 30?mg every 4 weeks × 3 months (ARM A, N?=?15), or pituitary surgery (ARM B, N?=?26) using a 1:2 randomization design. Patients cured by surgery (defined as nadir GH during oGTT? Results Only one of the 15 patients in ARM A (6.7%) had normalization of both GH and IGF-I. In contrast, 13/26 patients had normalization of both GH and IGF-I after surgery alone (50%). Of the remaining 13 patients who did not normalize with surgery alone, treatment with octreotide LAR resulted in a normal nadir GH and normal serum IGF-I in 7 (53.9%). In total, 20/26 in ARM B (76.9%) experienced normalization of defined biochemical acromegaly parameters. Conclusions Pituitary surgery alone was more effective than primary medical treatment (p?=?0.006), and the combination of surgery followed by medical therapy was even more effective (p?