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Shelly Bhayana, Gillian L. Booth, Sylvia L. Asa, Kalman Kovacs, Shereen Ezzat, The Implication of Somatotroph Adenoma Phenotype to Somatostatin Analog Responsiveness in Acromegaly, The Journal of Clinical Endocrinology & Metabolism, Volume 90, Issue 11, 1 November 2005, Pages 6290–6295, https://doi.org/10.1210/jc.2005-0998
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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 ≤3; 78.6% vs. 35.7%; P = 0.022), to have lower baseline IGF-I (453 vs. 716 μg/liter; P < 0.001) and GH levels (2.7 vs. 7.8 μg/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.
