Primary Treatment of Acromegaly with Octreotide LAR: A Long-Term (Up to Nine Years) Prospective Study of Its Efficacy in the Control of Disease Activity and Tumor Shrinkage

Context: Neurosurgery is regarded as the first-line treatment of acromegaly. Because of its low cure rate in macro and invasive adenoma, the role of primary medical treatment is debated. Objective: Our objective was to evaluate primary pharmacological treatment in acromegaly. Design and Setting: We conducted an open prospective study at two Italian tertiary level centers. Patients: We studied 67 consecutive patients (36 women; age, 54.9 ± 14.2 yr; 72% bearing macroadenoma). Intervention: Individually tailored octreotide LAR (OCLAR) was administered. Main Outcome Measures: Outcomes included safe GH (<2.5 μg/liter), normal age-matched IGF-I levels, and tumor shrinkage. Results: After a median follow-up of 48 months (range, 6–108 months), safe GH levels and normal age-matched IGF-I values were obtained by 68.7 and 70.1% of patients, respectively. Hormonal endpoints were achieved regardless of basal levels, and early results were predictive of outcome. Tumor shrank in 82.1% of patients by 62 ± 31% (range, 0–1...