Broson-Chazot F, Houzard C, Ajzenberg C, Nocaudie M, Duet M, Mundler O, Marchandise X, Epelbaum J, Gomez De Alzaga M, Schäfer J, Meyerhof W, Sassolas G, Warnet A
Centre de Médecine Nucléaire, Lyon, France.
Clin Endocrinol (Oxf). 1997 Nov;47(5):589-98. doi: 10.1046/j.1365-2265.1997.3361119.x.
A multicentre study was undertaken to determine the value of somatostatin receptor (sst) scintigraphy in predicting hormonal and visual responses to octreotide treatment in GH-secreting and non-functioning pituitary adenomas.
Somatostatin receptor scintigraphy was performed in 48 patients (19 acromegaly, 29 non-functioning pituitary adenomas with ophthalmological defects). Results were expressed as an uptake index of the pituitary area. A threshold for positivity was determined in 23 subjects considered as controls. Thirty-five patients were treated for 1 month with octreotide (300 micrograms daily). The therapeutic response was assessed on GH and IGF-I suppression or evolution of the ophthalmological defects. The relationships between the somatostatin receptor scintigraphy result, the therapeutic effect of octreotide and in vitro studies performed in 12 tumours were studied.
From the results of control subjects the uptake index threshold for positivity was 2. In patients, somatostatin receptor scintigraphy was positive in 64% and there was no relationship between uptake index and tumour size. In GH tumours, somatostatin receptor scintigraphy was positive in 68%; uptake index was related to octreotide-induced GH and IGF I suppression. The positive predictive value was 100% and the negative predictive value was 50%. In vitro studies showed detectable binding sites for somatostatin with sst2 and sst5 expression in the 4 GH tumours studied although somatostatin receptor scintigraphy was negative in 2 cases. In non-functioning pituitary adenomas somatostatin receptor scintigraphy was positive in 62%. Based on visual effects, the positive predictive value was 61% and the negative predictive value was 100%. A wide distribution of somatostatin binding sites was found in 8 non-functioning pituitary adenomas with expression of sst2 only.
In the conditions of the study, in patients with acromegaly, positive somatostatin receptor scintigraphy predicts a hormonal response but the value of somatostatin receptor scintigraphy is limited by its low negative predictive value. In patients with non-functioning pituitary adenomas, negative somatostatin receptor scintigraphy predicts that there will be no visual improvement during octreotide treatment.
开展一项多中心研究，以确定生长抑素受体（sst）闪烁扫描术在预测生长激素分泌型和无功能垂体腺瘤对奥曲肽治疗的激素及视觉反应方面的价值。
对48例患者（19例肢端肥大症患者、29例伴有眼科缺陷的无功能垂体腺瘤患者）进行生长抑素受体闪烁扫描术。结果以垂体区域摄取指数表示。在23例被视为对照的受试者中确定阳性阈值。35例患者接受奥曲肽治疗1个月（每日300微克）。根据生长激素（GH）和胰岛素样生长因子I（IGF-I）的抑制情况或眼科缺陷的进展评估治疗反应。研究了生长抑素受体闪烁扫描术结果、奥曲肽的治疗效果与对12个肿瘤进行的体外研究之间的关系。
根据对照受试者的结果，阳性摄取指数阈值为2。在患者中，生长抑素受体闪烁扫描术阳性率为64%，摄取指数与肿瘤大小之间无相关性。在生长激素瘤患者中，生长抑素受体闪烁扫描术阳性率为68%；摄取指数与奥曲肽诱导的生长激素和胰岛素样生长因子I抑制有关。阳性预测值为100%，阴性预测值为50%。体外研究显示，在所研究的4个生长激素瘤中，有生长抑素的可检测结合位点，且存在sst2和sst5表达，尽管其中2例生长抑素受体闪烁扫描术为阴性。在无功能垂体腺瘤中，生长抑素受体闪烁扫描术阳性率为62%。基于视觉效果，阳性预测值为61%，阴性预测值为100%。在8个仅表达sst2的无功能垂体腺瘤中发现生长抑素结合位点分布广泛。
在本研究条件下，对于肢端肥大症患者，生长抑素受体闪烁扫描术阳性可预测激素反应，但生长抑素受体闪烁扫描术的价值因其较低的阴性预测值而受限。对于无功能垂体腺瘤患者，生长抑素受体闪烁扫描术阴性可预测奥曲肽治疗期间视力不会改善。
