OBJECTIVE: Monthly injections of Sandostatin-LAR have been shown to be an effective therapy for patients with acromegaly. Because of an ongoing need to assess a patients response to definitive therapy such as surgery and/or radiotherapy, we aimed to evaluate GH levels and acromegaly symptom scores in patients withdrawing from Sandostatin-LAR. DESIGN AND PATIENTS: 12 patients with acromegaly previously treated with Sandostatin-LAR, 20-40 mg intramuscularly every 28 (n = 9) or 42 (n = 3) days for 12-36 months were studied at monthly intervals for 4 months following the withdrawal of the drug. MEASUREMENTS: Hourly fasting serum GH measurements between 0800 h and 1200 h, serum IGF-1 and symptom scores were undertaken at 4, 8, 12 and 16 weeks following the last injection of Sandostatin-LAR. MRI/CT scans of the pituitary were undertaken at 16 weeks and compared to scans taken on Sandostatin-LAR within the previous 10 months. RESULTS: Serum GH rose progressively from 7.7 (1.5 to 14.6) (median (range)) mIU/l at 4 weeks to 9.9 (1.5-21.8), to 12.6 (4.9-31.9) (P < 0.05 vs 4 weeks) and to 13.1 (6.0-39.1) mIU/l (P < 0.002) at 8, 12 and 16 weeks, respectively, following cessation of Sandostatin-LAR. IGF-1 rose from 38.5 (12.6-73.8) nmol/l at 4 weeks to 62.4 (37.4-159) at 16 weeks (P < 0.002) and mean symptom score (comprising headache, sweating, arthralgia, paraesthesiae, tiredness) from 4.0 (0 to 10) (4 weeks) to 4.5 (0-9) (8 weeks) to 6.0 (2-10) (12 weeks) to 6.5 (4-12) (16 weeks, P < 0.05). Individual GH profiles indicated a rise in GH in 5/12 patients between weeks 4-8 and between weeks 8-12 in a further 5/12 patients. There were no changes in pituitary tumour size following discontinuation of Sandostatin-LAR. CONCLUSIONS: GH and symptom scores rise progressively following discontinuation of Sandostatin-LAR in acromegalic patients. However, GH and symptom scores remain suppressed in some patients for at least 8 weeks following cessation of Sandostatin-LAR. We suggest that a withdrawal period of 3 months from Sandostatin-LAR is required in order to perform a meaningful re-assessment of GH and clinical status.
OBJECTIVE: Monthly injections of Sandostatin-LAR have been shown to be an effective therapy for patients with acromegaly. Because of an ongoing need to assess a patients response to definitive therapy such as surgery and/or radiotherapy, we aimed to evaluate GH levels and acromegaly symptom scores in patients withdrawing from Sandostatin-LAR. DESIGN AND PATIENTS: 12 patients with acromegaly previously treated with Sandostatin-LAR, 20-40 mg intramuscularly every 28 (n = 9) or 42 (n = 3) days for 12-36 months were studied at monthly intervals for 4 months following the withdrawal of the drug. MEASUREMENTS: Hourly fasting serum GH measurements between 0800 h and 1200 h, serum IGF-1 and symptom scores were undertaken at 4, 8, 12 and 16 weeks following the last injection of Sandostatin-LAR. MRI/CT scans of the pituitary were undertaken at 16 weeks and compared to scans taken on Sandostatin-LAR within the previous 10 months. RESULTS: Serum GH rose progressively from 7.7 (1.5 to 14.6) (median (range)) mIU/l at 4 weeks to 9.9 (1.5-21.8), to 12.6 (4.9-31.9) (P < 0.05 vs 4 weeks) and to 13.1 (6.0-39.1) mIU/l (P < 0.002) at 8, 12 and 16 weeks, respectively, following cessation of Sandostatin-LAR. IGF-1 rose from 38.5 (12.6-73.8) nmol/l at 4 weeks to 62.4 (37.4-159) at 16 weeks (P < 0.002) and mean symptom score (comprising headache, sweating, arthralgia, paraesthesiae, tiredness) from 4.0 (0 to 10) (4 weeks) to 4.5 (0-9) (8 weeks) to 6.0 (2-10) (12 weeks) to 6.5 (4-12) (16 weeks, P < 0.05). Individual GH profiles indicated a rise in GH in 5/12 patients between weeks 4-8 and between weeks 8-12 in a further 5/12 patients. There were no changes in pituitary tumour size following discontinuation of Sandostatin-LAR. CONCLUSIONS: GH and symptom scores rise progressively following discontinuation of Sandostatin-LAR in acromegalicpatients. However, GH and symptom scores remain suppressed in some patients for at least 8 weeks following cessation of Sandostatin-LAR. We suggest that a withdrawal period of 3 months from Sandostatin-LAR is required in order to perform a meaningful re-assessment of GH and clinical status.