GH secretory dynamics and responsiveness to SMS 201-995 treatment in acromegaly.

Recently, SMS 201-995, a long acting somatostatin analogue, has been used in successful therapy for inhibition of growth hormone (GH) levels in acromegaly. But, it was reported that inhibitory and clinical effects in the individual patient were different in many cases. Therefore, to find the predictive factor for patients with effective inhibition of GH, we investigated the paradoxical response to thyrotropin releasing hormone (TRH), growth hormone releasing hormone (GHRH) and diurnal variation of GH secretion between responders and non-responders to SMS 201-995. The results were as follows; Responders, patients with suppressive response to SMS 201-995, totalled 4 of 8 patients. The paradoxical response of GH to TRH was observed in 3 of 4 responders and 3 of 4 non-responders. The response of GH to GHRH was not noted in either of the groups. The diurnal variation of GH secretion showed in one of the responders and in 3 of the non-responders. These results suggested that the absence of diurnal variation of GH secretion was a characteristic feature of responders to SMS 201-995 and thus diurnal variation of GH secretion could be used as a predictive factor for SMS 201-995 therapy, and the pathogenetic mechanism of acromegaly might be dependent on the controlled regulation of GHRH and endogenous somatostatin.