Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single ce
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ORIGINAL ARTICLE
Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center Susanna Bacigaluppi1,4 • Federico Gatto3,4 • Pasquale Anania1 • Nicola Luigi Bragazzi2 Diego Criminelli Rossi1 • Giulia Benvegnu5 • Elena Nazzari3 • Renato Spaziante6 • Massimo Giusti3,4 • Diego Ferone3,4 • Gianluigi Zona1
•
Received: 31 December 2014 / Accepted: 27 April 2015 Ó Springer Science+Business Media New York 2015
Abstract First-line treatment of patients with growth hormone secreting adenomas is surgical resection. Disease control can be obtained by surgery (one or multiple steps), in case followed by medical treatment or adjuvant radiation therapy (radiosurgery or radiotherapy). The impact of presurgical treatment with somatostatin analogs (SSAs) on surgical outcome is still controversial. The aim of this study is to retrospectively evaluate the impact of SSA pre-treatment on biochemical outcome and post-surgical hypopituitarism in a consecutive surgical series from a single referral centre, with data covering 17 years’ experience and to investigate the possible predictive value of early postoperative insulin-like factor 1 (IGF-I) on long-term biochemical control. Data from 68 acromegalic patients were revised. Endocrinological long-term follow-up (minimum 6 months)
Susanna Bacigaluppi and Federico Gatto have contributed equally to this work. & Gianluigi Zona [email protected] 1
Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132 Genova, Italy
2
School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
3
Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
4
Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
5
Anaesthesiology, Department of Emergency (DEA), IRCCS San Martino-IST, Genova, Italy
6
Department of Neurosurgery, University of Salerno, Salerno, Italy
was available for 57 patients. Eighty-eight percent of patients received a single-step surgical treatment (single surgery, with or without adjuvant medical therapy). The remaining 12 % underwent a multi-step strategy: redo-surgery (three macroadenomas) and/or radiation (four macroand two microadenomas). Pre-surgical SSA treatment was performed in 77.9 % and resulted in a significant lowering of basal IGF-I values (p = 0.0001). Early post-surgical IGF-I was significantly lower in patients biochemically controlled with single surgery alone (p = 0.016) and after overall treatment strategies (p = 0.005). Normalization of GH and IGF-I was obtained in 56.1 %, and normalization of either one of them in 27.8 % of patients. No major surgery-related complications occurred. Post-treatment hypopituitarism occurred in 11.9 % and was lower in SSA pre-treated patients. Our results well compare with other recently published series. Very early post-surgical IGF-I improvem
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