Pros and cons in endocrine practice: pre-surgical treatment with somatostatin analogues in acromegaly

Endocrine
Marco Losa, J Bollerslev

Abstract

The aim of this commentary is to balance the pros and cons for pre-surgical SSA treatment in a modern perspective ending up with a pragmatic recommendation for treatment based on the current evidence and expertise of the authors. Even though prospective and randomized studies in this particular area are hampered by obvious limitations, the interpretation of the four published trials has in general been in favor of pre-treatment with SSA, showing a better outcome following surgery. However, major drawbacks of these studies, such as non-optimal diagnostic criteria for cure, potential selection bias, and timing of the postoperative evaluation in SSA pre-treated patients, limit their overall interpretation. Three matched-controlled studies showed remarkably similar results with no apparent beneficial effect of SSA pre-treatment on surgical outcome. Both prospective, randomized studies and retrospective studies did not find any significant difference in the rate of endocrine and non-endocrine complications related to surgery, despite the beneficial clinical effects of SSA treatment in most acromegalic patients. The newly diagnosed patient with acromegaly should be carefully evaluated in the trans-disciplinary neuroendocrine team and...Continue Reading

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Citations

Sep 12, 2020·Reviews in Endocrine & Metabolic Disorders·Andrea GiustinaShlomo Melmed
Apr 3, 2021·Frontiers in Endocrinology·Manel Puig-DomingoMónica Marazuela

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