Short-term preoperative octreotide treatment of GH-secreting pituitary adenoma: predictors of tumor shrinkage.
Short-term preoperative octreotide treatment of GH-secreting pituitary adenoma: predictors of tumor shrinkage.
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DOI：
10.1507/endocrj.53.125
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发表时间：
2006-02
影响因子：
2
通讯作者：
S. Oshino;Y. Saitoh;S. Kasayama;N. Arita;T. Ohnishi;H. Kohara;S. Izumoto;T. Yoshimine
中科院分区：
文献类型：
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作者：
S. Oshino;Y. Saitoh;S. Kasayama;N. Arita;T. Ohnishi;H. Kohara;S. Izumoto;T. Yoshimine
我们回顾了32例在经蝶手术前接受短期奥曲肽治疗的生长激素（GH）分泌性大腺瘤患者的病例，以确定哪种类型的腺瘤术前治疗是敏感的，以及是否可以确定肿瘤缩小的预测因素。回顾性评价了32例患者术前奥曲肽治疗的效果、内分泌效果和对肿瘤体积的影响，这些影响与磁共振图像上的肿瘤特征和对内分泌激发试验的反应有关。奥曲肽每日剂量为300 μ g，持续2-3周，血清GH和胰岛素样生长因子-1（IGF-1）水平分别降至治疗前值的31.9%和51.6%，52%的患者平均肿瘤体积为治疗前体积的68%。Knosp 0-2级的内分泌效应和对肿瘤体积的影响大于Knosp 3-4级。奥曲肽和溴隐亭激发试验反应良好的患者肿瘤缩小明显更常见。对于手术切除肿瘤，将肿瘤缩小至治疗前体积的68%的效果将有利于Knosp 1-2级的大腺瘤。术前短期奥曲肽治疗对Knosp分级1-2的GH分泌性大腺瘤有效，对奥曲肽和溴隐亭激发试验的良好反应是随后肿瘤缩小的预测因素。这些结果将导致更有效地选择患者术前奥曲肽治疗。
We reviewed the cases of 32 patients with growth hormone (GH)-secreting macroadenoma who underwent short-term octreotide treatment before transsphenoidal surgery to determine which types of adenoma the preoperative treatment were sensitive and whether predictors of tumor shrinkage could be identified. The effects of preoperative octreotide treatment, endocrinologic effect and effect on tumor volume in 32 patients were evaluated retrospectively in relation to tumor features on magnetic resonance images and responses to endocrinologic challenge tests. At a daily dose of 300 microg for 2-3 weeks, octreotide reduced serum GH and insulin-like growth factor-1 (IGF-1) levels to 31.9 % and 51.6% of pretreatment values, respectively, and led to a mean tumor volume of 68% of pretreatment volume in 52% of the patients. The endocrinologic effect and the effect on tumor volume were larger in Knosp grades 0-2 than in Knosp grades 3-4. Tumor shrinkage occurred significantly more often among patients that had a good response to both octreotide and bromocriptine challenge tests. For surgical removal of the tumor, the effect of reducing tumor to 68% of pretreatment volume will be beneficial for the macroadenomas of Knosp grades 1-2. Preoperative short-term octreotide treatment is effective for GH-secreting macroadeomas of Knosp grades 1-2 and a good response to both octreotide and bromocriptine challenge tests is a predictor of subsequent tumor shrinkage. These results will lead to more effective selection of patients for preoperative octreotide treatment.