Effect of gender and gonadal status on the long-term response to somatostatin analogue treatment in acromegaly

Annamaria Colao, Rosario Pivonello, Paolo Cappabianca, Francesco Briganti, Fabio Tortora, Renata S. Auriemma, Maria Cristina De Martino, Paolo Marzullo, Gaetano Lombardi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: GH and IGF-I secretion is related to gender and age. Objective: To evaluate the impact of gender and gonadal status on the long-term sensitivity to the somatostatin analogues depot octreotide long-acting release (OCT-LAR) and lanreotide (LAN). Patients: Seventy-three patients with active acromegaly (37 women, median age 34 years; 36 men, median age 38 years) who had not previously been treated with somatostatin analogues were studied: 24 women and 23 men were newly diagnosed; 22 men (61.1%) and 17 women (45.9%) had hypogonadism (P = 0.28). Exclusion criteria were age > 45 years, follow-up less than 12 months, mixed GH/PRL-secreting adenomas. Study design: Observational, analytical, retrospective. Outcome measures: (1) Disease control measured as serum GH <2.5 μg/l and IGF-I normal for age and gender; (2) reduction in tumour volume graded as absent (<25%), mild (25-50%) and notable (> 50%). Results: Basal GH, but not IGF-I, levels were higher in women than in men both in the entire series and in 'de novo' patients (97.8 ± 42.2 vs. 71.1 ± 32.6 μg/l, P = 0.021). After 12 and 24 months of treatment, respectively, disease control was achieved similarly in men (57.1 and 86.7%) and women (48.6 and 86.7%). Hypogonadal men had longer disease duration than eugonadal men (P = 0.022), without any difference in the other parameters. No difference was found between eugonadal and hypogonadal women. Eugonadal men had a smaller tumour volume at baseline than eugonadal women (1396 ± 794 vs. 2896 ± 2871 mm3, P = 0.025). In men undergoing testosterone replacement and withdrawal, there was no change in GH and IGF-I levels after 12 and 24 months of treatment with either LAR or LAN. In the seven women receiving oestro-progestinic replacement, after 24 months of LAR or LAN treatment GH levels were higher during replacement than at withdrawal and IGF-I levels were lower during replacement than withdrawal. Tumour volume decreased significantly in both women and men without any difference between them: the percentage tumour shrinkage in men and women was similar either after 12 (34.4 ± 24.4 vs. 40.7 ± 22.5%, P = 0.38) or 24 months of treatment (58.5 ± 17.4 vs. 56.1 ± 23.6%, P = 0.75). Similarly, there was no difference in tumour volume between hypogonadal and eugonadal women and men. Conclusions: The results of this study demonstrate that long-term responsiveness to OCT-LAR is similar in women and men. Care should be taken in women with acromegaly and hypogonadism treated with somatostatin analogues and oral oestro-progestinic as in this case GH levels are higher while IGF-I levels are lower than after the somatostatin analogues alone.

Original languageEnglish
Pages (from-to)342-349
Number of pages8
JournalClinical Endocrinology
Volume63
Issue number3
DOIs
Publication statusPublished - Sep 2005

ASJC Scopus subject areas

  • Endocrinology

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