Colao A, Ferone D, Cappabianca P, del Basso De Caro M L, Marzullo P, Monticelli A, Alfieri A, Merola B, Calì A, de Divitiis E, Lombardi G
Department of Molecular and Clinical Endocrinology, Federico II University, Naples, Italy.
J Clin Endocrinol Metab. 1997 Oct;82(10):3308-14. doi: 10.1210/jcem.82.10.4283.
Pretreatment with octreotide (OCT) in acromegaly has been reported to improve surgical outcome. The objective of this study was to analyze retrospectively the effects of a 3- to 6-month presurgical treatment with OCT in acromegalics focusing on electrocardiographic (ECG) records, blood pressure levels, glucose and lipid profile, tumor size and consistency, easy tumor removal at surgery, and morphological findings at pathology. Fifty-nine patients with acromegaly who were undergoing surgical treatment were studied randomly before surgery; 37 patients were untreated, and 22 were treated with OCT at doses ranging 150-600 micrograms/day for 3-6 months. At study entry, untreated and OCT-treated patients had similar circulating GH and insulin-like growth factor I (IGF-I), glucose, and cholesterol levels as well as prevalence of overt diabetes mellitus, hypertension, and ECG abnormalities. In untreated and OCT-treated patients, respectively, radiological imaging documented microadenoma in 0 and 1, intrasellar macroadenoma in 10 and 6, intra- and suprasellar macroadenoma in 18 and 11, invasive macroadenoma in 9 and 4 patients. Before surgery, serum GH and IGF-I levels significantly decreased in the 22 OCT-treated acromegalics, and in 5 of them, a significant shrinkage was documented. ECG abnormalities disappeared in 7 of 11 (63.6%) OCT-treated patients. In 3 of the 7 patients with diabetes mellitus, treatment with OCT together with low carbohydrate intake normalized blood glucose levels, whereas in 2 patients, insulin could be replaced by oral antidiabetics, and in 2 patients, the insulin dose was reduced. Presurgical blood glucose, total cholesterol and triglyceride levels, as well as systolic (145.2 +/- 3.4 vs. 132.9 +/- 2.5 mm Hg; P < 0.01) and diastolic (94.3 +/- 1.7 vs. 84.3 +/- 1.6 mm Hg; P < 0.001) blood pressure levels were significantly higher in untreated than in OCT-treated patients. Two weeks after surgery, circulating GH and IGF-I levels were normalized in 11 untreated (29.7%) and 12 OCT-treated (54.5%) patients (P < 0.005, by chi 2 test). Macroscopically, no difference was found between untreated and OCT-treated adenomas, whereas at pathology, a significant increases in cellular atypia (31.6% vs. 19.2%; P < 0.05) was found in OCT-treated adenomas. One patients in the untreated group died from cardiorespiratory arrest during the early postoperative period. Finally, the average duration of hospitalization after operation was longer in untreated than in OCT-treated patients (8.6 +/- 0.7 vs. 5.6 +/- 0.5 days). We conclude that a 3- to 6-month treatment with OCT before surgery for GH-secreting adenoma improved clinical conditions and surgical outcome and reduced the duration of hospitalization after operation.
据报道，肢端肥大症患者术前使用奥曲肽（OCT）可改善手术效果。本研究的目的是回顾性分析OCT对肢端肥大症患者进行3至6个月术前治疗的效果，重点关注心电图（ECG）记录、血压水平、血糖和血脂情况、肿瘤大小和质地、手术中肿瘤的易切除性以及病理形态学表现。对59例接受手术治疗的肢端肥大症患者在术前进行随机研究；37例患者未接受治疗，22例患者接受OCT治疗，剂量为150 - 600微克/天，持续3 - 6个月。研究开始时，未治疗组和OCT治疗组患者的循环生长激素（GH）、胰岛素样生长因子I（IGF - I）、血糖和胆固醇水平，以及显性糖尿病、高血压和ECG异常的患病率相似。在未治疗组和OCT治疗组患者中，影像学检查分别显示0例和1例微腺瘤，10例和6例鞍内大腺瘤，18例和11例鞍内及鞍上大腺瘤，9例和4例侵袭性大腺瘤。术前血清GH和IGF - I水平在22例接受OCT治疗的肢端肥大症患者中显著下降，其中5例有明显缩小。11例接受OCT治疗的患者中有7例（63.6%）ECG异常消失。7例糖尿病患者中有3例，OCT治疗联合低碳水化合物饮食使血糖水平恢复正常，2例患者胰岛素可被口服降糖药替代，2例患者胰岛素剂量减少。术前未治疗组患者的血糖、总胆固醇和甘油三酯水平以及收缩压（145.2±3.4 vs. 132.9±2.5 mmHg；P < 0.01）和舒张压（94.3±1.7 vs. 84.3±1.6 mmHg；P < 0.001）血压水平显著高于OCT治疗组。术后两周，11例未治疗患者（29.7%）和12例OCT治疗患者（54.5%）的循环GH和IGF - I水平恢复正常（经卡方检验，P < 0.005）。宏观上，未治疗组和OCT治疗组的腺瘤无差异，但在病理检查中，OCT治疗组腺瘤的细胞异型性显著增加（31.6% vs. 19.2%；P < 0.05）。未治疗组有1例患者在术后早期死于心肺骤停。最后，未治疗组患者术后平均住院时间长于OCT治疗组（8.6±0.7 vs. 5.6±0.5天）。我们得出结论，对于分泌GH的腺瘤，术前3至6个月使用OCT治疗可改善临床状况和手术效果，并缩短术后住院时间。
