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Results of the International Multicenter Acromegaly Study Group

Mary Lee Vance, MD; Alan G. Harris, MD

Arch Intern Med. 1991;151(8):1573-1578.

Abstract
Background
We wanted to determine the clinical and biochemical effects of long-term therapy with the somatostatin analog octreotide in 189 acromegalic patients.

Methods
Patients were treated at 23 medical centers for 6 days to 231 weeks (median, 24.2 weeks) with varying octreotide dosages (100 to 1500µg/d; median, 300 µg/d). Serum growth hormone and insulin-like growth factor I (IGF-I) concentrations before and at the end of the study were compared, and correlations between the response to treatment with total daily dosage and duration of treatment were sought.

Results
The clinical response rate was 88%, irrespective of dosage or treatment duration. Serum growth hormone levels decreased in 172 (94%) of 182 patients and IGF-I levels decreased in 91 (92%) of 99. The mean pretreatment growth hormone level was 39.4 ±4.4 µg/L and decreased to 12.2 ±1.5 µg/L. Growth hormone levels decreased to less than 5 µg/L in 82 (45%) of 182 patients. The pretreatment IGF-I level was 5.62±0.41 U/mL and decreased to 2.64 ±0.19 U/mL; suppression to 2 U/mL or lower occurred in 46 (46%) of 99 patients. The degree of growth hormone suppression was associated with longer treatment duration but not with the total octreotide dosage per day. In 34 patients studied prospectively, pituitary tumor size decreased by greater than 20% in 15 (44%). Side effects occurred in 37% of patients and were most commonly transient loose acholic stools, pain at the injection site, and abdominal discomfort; severity was mild to moderate. Glucose tolerance was unchanged or improved in 52% and declined in 48% of 25 patients evaluated.

Conclusions
Octreotide is an effective treatment for acromegaly that may be used as primary therapy or after surgery and/or pituitary irradiation.

(Arch Intern Med. 1991;151:1573-1578)

Author Affiliations
From the Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, Va (Dr Vance), and the Department of Neuroendocrinology and Biostatistics, Clinical Research, Sandoz Ltd, Basel, Switzerland (Dr Harris).

Footnotes
Accepted for publication January 22, 1991.

Reprint requests to Box 511, University of Virginia Health Sciences Center, Charlottesville, VA 22908 (Dr Vance).

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