Octreotide in the management of active acromegaly due to inoperable growth hormone-secreting adenoma

Active acromegaly displays high morbidity and mortality. It should be treated aggressively with surgery, radiotherapy and medical therapy. In order to confirm the effectiveness and tolerability of octreotide in refractory acromegaly, we studied six patients after unsuccessful transsphenoidal surgery, or surgery and conventional radiotherapy performed for pituitary macroadenomas. After nuclear magnetic resonance imaging and hormonal studies, they were submitted to octreotide therapy (100 micrograms subcutaneously every eight hours), reevaluated every six weeks for six months, and followed-up for further six months. A clear reduction of subjective symptoms including headache was noticed. Two patients, however, suffered from recurrent malaise and reduced octreotide doses (one case, who also developed cholelithiasis), or refused to continue the treatment. GH and IGF-I levels were normalized (1 patient), improved (3 patients) or unmodified (2 patients). Not every acromegalic patient responds to low-dose octreotide therapy with normalization of GH levels. In selected cases, however, octreotide may be usefully employed for active acromegaly in support of surgery and radiotherapy.