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Preliminary data on biochemical remission of acromegaly after somatostatin analogs withdrawal

¹ Unit of Endocrinology, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F. Sforza, 35, 20122 Milan, Italy² Department of Medical Sciences, University of Milan, 20122 Milan, Italy³ Unit of Endocrinology, Osp. S. Giuseppe-Milanocuore AFaR, 20123 Milan, Italy⁴ Department of Molecular and Clinical Endocrinology and Oncology, Section of Endocrinology, Federico II University of Naples, 80131 Naples, Italy and ⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, San Giovanni Battista-Molinette Hospital, University of Turin, 10126 Turin, Italy

(Correspondence should be addressed to C L Ronchi; Email: cristina.ronchi{at}unimi.it)

Objective: It is still unknown whether prolonged treatment with somatostatin analogs (SSTa) may cause a long-lasting disease remission in GH-secreting adenomas after drug discontinuation. The aim of the present study was to investigate the evolution of GH/IGF-I secretion and tumor mass after SSTa withdrawal in patients affected by acromegaly.

Patients and Design: A total of 27 patients with acromegaly (12 de novo and 15 previously operated) were treated with SSTa for a median period of 48 months and considered optimally controlled in hormonal and neuroradiological terms. None of them were previously irradiated.

Methods: Basal GH, post-glucose GH nadir, IGF-I, clinical signs/symptoms, and metabolic parameters were evaluated after 12–16 weeks from drug withdrawal. Only patients who met the current criteria for disease remission remained in drug suspension being periodically re-evaluated for biochemical/clinical data and neuroradiological imaging.

Results: After 12–16 weeks withdrawal, 15 of the 27 patients had disease relapse and restarted SSTa, while 12 were considered ‘in disease remission’ (44% of total). Glucose metabolism improved in both euglycemic and diabetic patients after short-term SSTa discontinuation. Only one of the ten patients who reached 24 weeks withdrawal showed biochemical disease recurrence. On the whole, five of the patients still in remission after 6 months have already prolonged the follow-up over 12 months (median: 24 months), without clinical and biochemical/neuroradiological evidence of disease recurrence.

Conclusions: These preliminary data indicate a successful withdrawal of SSTa at least in a subset of well-responsive patients with acromegaly and challenge the previously held concept that medical therapy is always a lifelong requirement.