Pre-surgical medical treatment, a major prognostic factor for long-term remission in acromegaly

purposeto determine whether pre-surgical medical treatment (psmt) using long-acting somatostatin analogues in acromegaly may improve long-term surgical outcome and to determine decision making criteria. methods:this retrospective study included 110 consecutive patients newly diagnosed with acromegaly, who underwent surgery in a reference center (marseille, france). the mean long-term follow-up period was 51.4 ± 36.5 (median 39.4) months. sixty-four patients received psmt during 3–18 (median 5) months before pituitary surgery. remission was defined at early (3 months) evaluation and at last follow-up by gh nadir after oral glucose tolerance test < 0.4 µg/l and normal igf-1. results:pretreated and non-pretreated groups were comparable for the main confounding factors except for higher igf-1 at diagnosis in psmt patients. remission rates were significantly different in pretreated or not pretreated groups (61.1% vs. 36.6%, respectively at long-term evaluation). in multivariate analysis, psmt was significantly linked to 3 months (p < 0.01) and long-term remission (p < 0.01). duration of psmt was not significantly different in cured or non-cured patients, at both evaluation times. psmt appeared to be more beneficial for patients with an invasive tumor. no patient with a tumor greater than 18 mm or mean gh level exceeding 35 ng/ml at diagnosis was cured by surgery alone (vs. 8 and 9 patients in the pretreated group, respectively). patients with psmt showed more transient mild hyponatremia after surgery. conclusion:spsmt significantly improved short and long-term remission in patients with acromegaly, independent of its duration, especially in invasive adenomas.