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J Clin Endocrinol Metab. 2005 Nov;90(11):6290-5. Epub 2005 Aug 23.

The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly.

Author information

1
Department of Medicine, Mount Sinai Hospital, 600 University Avenue, Room 437, Toronto, Ontario, Canada M5G 1X5.

Abstract

CONTEXT:

Persistently elevated GH and IGF-I levels are associated with increased mortality. Their response to somatostatin analogs (SSA) is variable.

OBJECTIVE:

The objective of this study was to examine the significance of somatotroph adenoma type on response to SSA.

DESIGN:

This study was a retrospective examination of postoperatively treated acromegalic patients with the SSA octreotide.

SETTING:

The study was performed at a university-affiliated tertiary care center.

PATIENTS:

Forty patients with acromegaly were studied.

MAIN OUTCOME MEASURES:

Normalization of IGF-I levels and GH responses were the main outcome measures.

RESULTS:

Univariate analysis revealed that responders were more likely to have densely granulated somatotroph adenomas (80% vs. 43.8%; P = 0.024), to be older (51.3 vs. 38.2 yr; P < 0.003), to have smaller tumors (stage < or =3; 78.6% vs. 35.7%; P = 0.022), to have lower baseline IGF-I (453 vs. 716 microg/liter; P < 0.001) and GH levels (2.7 vs. 7.8 microg/liter; P < 0.05), and to require a lower maximum dose of SSA (24 vs. 31 mg every 4 wk; P = 0.013). Multivariate analysis confirmed that a densely granulated adenoma was the strongest predictor of complete response [adjusted odds ratio (OR), 58.41; 95% confidence interval (CI), 1.24-1000.00; P = 0.04] compared with other covariates, including older age at time of diagnosis (OR, 1.15/yr; 95% CI, 1.01-1.31; P = 0.03), and tumor stage of 3 or less (OR, 29.77; 95% CI, 1.01-885.45; P < 0.05).

CONCLUSIONS:

Somatotroph tumor type represents a strong clinical predictor of response to SSA treatment and will help to identify patients who warrant more vigilant management of their disease.

PMID:
16118335
DOI:
10.1210/jc.2005-0998
[Indexed for MEDLINE]

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