Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide: results of the International Multicenter Acromegaly Study Group

Article Abstract:

Acromegaly is a relatively uncommon disorder (40 to 68 cases per million population) caused by oversecretion of growth hormone by a tumor of the pituitary gland. It is characterized by gradual onset of distorted facial features, with alterations of the structure of facial bones and teeth. Complications include premature mortality from cardiovascular, cerebrovascular, respiratory and malignant diseases, as well as increased frequency of headaches, diabetes mellitus, high blood pressure, arthritis, muscular weakness and visual impairment. Although treatment by surgical removal of the pituitary is routine, about 50 percent of the patients continue to show hypersecretion of growth hormone. Alternative treatments include irradiation of the pituitary, which may take years to be effective, and drug treatment. A novel drug for the treatment of this disorder, octreotide (an analog of the endogenous growth hormone antagonist somatostatin), appears to be effective, but has not been adequately tested in clinical trials. To evaluate the effects of octreotide in the treatment of acromegaly, 82 men and 107 women with active acromegaly (aged 18 to 77 years) were studied at 23 medical centers in 15 countries. Patients were administered octreotide by subcutaneous injection at one of several doses, and treatment was continued for between 6 days and 231 weeks, depending on the design of the particular study. The response rate was 88 percent. In 94 percent of the patients, a decrease in growth hormone levels was seen; in 92 percent there was a decrease in the levels of insulin-like growth factor (a mediator of the effects of growth hormone). The degree of growth hormone suppression was related to the duration of treatment, but not to the daily drug dosage. In 44 percent of the patients tested, pituitary tumor size decreased by greater than 20 percent. Side effects (which occurred in 37 percent of the patients) included loose stools, pain at the site of the injection, and abdominal discomfort. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Chemotherapy, Somatostatin, Pituitary gland tumors, Pituitary tumors, Octreotide acetate

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Remission of polycythemia vera after surgical cure of acromegaly

Article Abstract:

Polycythemia vera associated with acromegaly may go into remission when the acromegaly is surgically treated, suggesting that polycythemia may be caused by insulin-like growth factor I (IGF-1) or growth hormone. Polycythemia vera is the excessive growth of certain bone marrow cells resulting in increased red blood cell mass. A 42-year-old man with polycythemia had acromegaly, enlarged body parts, and elevated levels of growth hormone and IGF-1. A benign tumor was removed from his pituitary gland and his acromegaly and polycythemia resolved. His hormone levels also returned to normal. The resolution of the polycythemia accompanied by a decrease in growth hormone and IGF-1 levels suggest that polycythemia may be caused by hypersensitivity of bone marrow cells to these hormones.

Complications and side effects, Polycythemia vera

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