scholarly journals Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future

2016 ◽  
Vol 23 (12) ◽  
pp. R551-R566 ◽  
Author(s):  
Kjell Öberg ◽  
Steven W J Lamberts
Keyword(s):  
Medical Therapy ◽  
Neuroendocrine Tumours ◽  
Clinical Success ◽  
Serum Insulin ◽  
Therapeutic Option ◽  
Hormone Secretion ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Prolonged Release ◽  
Gastroenteropancreatic Neuroendocrine Tumours

Acromegaly is a hormonal disorder that arises when the pituitary gland secretes excess growth hormone (GH), which in turn stimulates a concomitant increase in serum insulin-like growth factor 1 (IGF-1) levels. Gastroenteropancreatic neuroendocrine tumours (GEP-NET) constitute a heterogeneous group of tumours that can secrete serotonin and a variety of peptide hormones that may cause characteristic symptoms known as carcinoid syndrome or other symptoms and hormonal hypersecretion syndromes depending on the tumour’s site of origin. Current medical therapy for the treatment of acromegaly and GEP-NET involves the administration of somatostatin analogues that effectively suppress excess hormone secretion. After its discovery in 1979, octreotide became the first synthetic biologically stable somatostatin analogue with a short-acting formulation of octreotide introduced into clinical practice in the late 1980s. Lanreotide, another somatostatin analogue, became available in the mid-1990s initially as a prolonged-release formulation administered every 10 or 14 days. Long-acting release formulations of both octreotide (Sandostatin LAR and Novartis) and lanreotide (Somatuline Autogel, Ipsen), based on microparticle and nanoparticle drug-delivery technologies, respectively, were later developed, which allowed for once-monthly administration and improved convenience. First-generation somatostatin analogues remain one of the cornerstones of medical therapy in the management of pituitary and GEP-NET hormone hypersecretion, with octreotide having the longest established efficacy and safety profile of the somatostatin analogue class. More recently, pasireotide (Signifor), a next-generation multireceptor-targeted somatostatin analogue, has emerged as an alternative therapeutic option for the treatment of acromegaly. This review summarizes the development and clinical success of somatostatin analogues.

Aggravation of hypoglycemia in insulinoma patients by the long-acting somatostatin analogue octreotide (Sandostatin®)

1989 ◽  
Vol 121 (1) ◽  
pp. 34-40 ◽  
Author(s):  
C. D. A. Stehouwer ◽  
W. F. Lems ◽  
H. R. A. Fischer ◽  
W. H. L. Hackeng ◽  
M. A. B. Naafs
Keyword(s):  
Blood Glucose ◽  
Hormone Secretion ◽  
Somatostatin Analogues ◽  
Serum Glucose ◽  
Somatostatin Analogue ◽  
Transient Decrease ◽  
Glucoregulatory Hormones ◽  
Octreotide Therapy ◽  
Long Acting ◽  
Analogue Octreotide

Abstract. Recently somatostatin analogues were successfully used to control insulin-induced hypoglycemia in patients with insulinoma. We observed a transient decrease in glucose levels and symptomatic hypoglycemia after administration of the long-acting somatostatin analogue octreotide (Sandostatin®) in two insulinoma patients. We studied the acute effects of octreotide (administered before breakfast) on blood glucose and glucoregulatory hormones in these patients. In one patient, we studied the effects of glucagon replacement and changing the time of breakfast (relative to octreotide administration) on octreotide-associated changes in blood glucose and glucoregulatory hormones. Compared with control levels, octreotide therapy reduced insulin levels. During hypoglycemia glucagon and growth hormone levels were suppressed, but cortisol levels appropriately increased. The increase in catecholamine levels was normal in one patient, but markedly attenuated in the other. A transient decrease in serum glucose after octreotide was absent after glucagon replacement, but present when breakfast was taken before administration of octreotide. We conclude that in patients with insulinoma, octreotide therapy may be associated with clinically important hypoglycemia, during which counterregulatory hormone secretion may be attenuated.

Diagnosis and Management of Acromegaly in 2012

2010 ◽  
Vol 8 (1) ◽  
pp. 48
Author(s):  
Laurence Katznelson ◽  
Keyword(s):  
Medical Therapy ◽  
De Novo ◽  
Therapeutic Option ◽  
Premature Mortality ◽  
Somatostatin Analogues ◽  
Gh Secretion ◽  
Gh Receptor Antagonist ◽  
Failed Surgery ◽  
Multimodality Approach

Acromegaly is an insidious disease that, in most cases, is a result of a pituitary adenoma that hypersecretes growth hormone (GH). The goals of therapy are to control excess GH secretion and tumour growth, and to limit, if not reverse, the long-term medical consequences and risk of premature mortality associated with acromegaly. Surgery is the preferred primary therapeutic option because it can lead to rapid reductions in GH levels and prevent mass effects from local tumor growth. Medical therapy, including somatostatin analogues, dopamine agonists, and the GH receptor antagonist pegvisomant, is used most often in an adjuvant, secondary role for patients in whom surgery has been unsuccessful. Radiation therapy is most commonly recommended in the setting of failed surgery and lack of adequate control with medical therapy. A role of primary medical therapy for de novo patients has been proposed, particularly with somatostatin analogues. Using a multimodality approach, successful management of the disease and associated consequences should be achieved in the majority of subjects.

Changes in the Options for Management of Prolactin Secreting Pituitary Adenomas

2021 ◽  
Author(s):  
Sherry L. Iuliano ◽  
Wenya Linda Bi ◽  
Edward R. Laws
Keyword(s):  
Side Effects ◽  
Medical Therapy ◽  
Therapeutic Option ◽  
Hormone Secretion ◽  
Three Dimensional ◽  
Pituitary Tumors ◽  
Initial Therapy ◽  
Fat Graft ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Endoscopic Operation

Abstract Objectives Initial therapy for the management of prolactinomas has long been maintained to be medical, consisting of a dopamine agonist. These therapies may have troublesome side effects, and some prolactinomas are resistant to medical therapy regarding lowering prolactin levels or shrinking the tumor. These issues have revived interest in surgery for prolactin-secreting adenomas as an early therapeutic option. We report our analysis of surgery for prolactin microadenomas in women, using the transsphenoidal endoscopic approach. Design We reviewed a contemporary series of 33 women (mean age = 31.8 years) with microprolactinomas who underwent early surgical intervention, which was a three-dimensional transnasal transsphenoidal endoscopic operation. Setting The study was conducted at a tertiary academic referral center for pituitary tumors. Main Outcome Measures Preoperative and postoperative prolactin. Results Overall, 28 patients had received preoperative dopamine agonists, 24 of these experienced a variety of drug-related side effects, and 4 had tumors that were resistant to lowering prolactin or tumor shrinkage. Preoperative prolactin levels averaged 90.3 ng/mL (range = 30.7–175.8 ng/mL). We observed a 94% normalization rate in postoperative prolactin (mean = 10.08 ng/mL, range = 0.3–63.1 ng/mL). During the follow-up (mean = 33.9 months), five patients had elevated prolactin; four required reinitiation of medical therapy, two had surgical reexploration, and none received radiation therapy. Complications included syndrome of inappropriate antidiuretic hormone secretion (n = 3), transient diabetes insipidus (n = 1), postoperative epistaxis (n = 1), and fat graft site infection (n = 1). Conclusion This review supports the consideration of transsphenoidal surgery as an early intervention for some women with prolactin-secreting microadenoma. Indications include significant side effects of medical therapy and tumors that do not respond to standard medical management.

scholarly journals Efficacy of somatostatin analogues in the treatment of neuroendocrine tumours based on the results of recent clinical trials

2014 ◽  
Vol 155 (48) ◽  
pp. 1908-1912 ◽  
Author(s):  
Péter Igaz
Keyword(s):  
Tumour Growth ◽  
Neuroendocrine Tumours ◽  
Hormone Secretion ◽  
Progression Free Survival ◽  
Symptomatic Treatment ◽  
Somatostatin Analogues ◽  
Inhibitory Effect ◽  
Inhibitory Effects ◽  
Free Survival ◽  
Clinical Observations

Due to their inhibitory effects on hormone secretion, somatostatin analogues are of pivotal importance in the symptomatic treatment of hormone-secreting neuroendocrine tumours. Although several earlier clinical observations supported the view that these biological agents are capable of inhibiting the growth of neuroendocrine tumours, the PROMID study published in 2009 was the first to confirm the inhibitory effect of octreotide on tumour growth and demonstrated the prolongation of progression free survival. These findings have been confirmed and extended by the most recent CLARINET trial with lanreotide published in 2014. Somatostatin analogues are capable of inhibiting tumour growth and stabilizing disease irrespective of the hormonal activity of the tumour and, therefore, their applicability is expected to be extended to the treatment of hormonally inactive neuroendocrine tumours, as well. Orv. Hetil., 2014, 155(48), 1908–1912.

scholarly journals Long Acting Somatostatin Analogue: Clinical Potential for Gastrointestinal Disease

1989 ◽  
Vol 3 (2) ◽  
pp. 77-81 ◽  
Author(s):  
Richard N. Fedorak
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Hemorrhage ◽  
Neuroendocrine Tumours ◽  
Gastrointestinal Disease ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Short Bowel ◽  
Long Acting ◽  
Clinical Potential ◽  
Biological Actions

Name somatostatin is found throughout the gastrointestinal tract and has a wide variety of biological actions. Nevertheless, its short biological half-life and limited stability necessitate its use via continuous parenteral infusion and, thus, limits its therapeutic usefulness The development of long acting somatostatin analogues have lead to a re-examination of the therapeutic usefulness of somatostatin in gastrointestinal disease. Somatostatin analogues appear most beneficial tn preventing symptoms associated with neuroendocrine tumours. In addition, case controlled studies exist to demonstrate somatostatin analogue effectiveness in treatment of gastrointestinal hemorrhage, pancreatic fistula, pancreatitis, short bowel syndrome and dumping syndrome.

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