Adults who need medical maintenance treatment of the growth hormone disorder acromegaly respond well to an investigational oral form of the drug octreotide, investigators of the Chiasma OPTIMAL study reported. Results of the phase 3 randomized controlled clinical trial were accepted for presentation at ENDO 2020, the Endocrine Society’s annual meeting, and will be published in the Journal of the Endocrine Society.
Two types of somatostatin analogs are available: octreotide (brand name Sandostatin) and lanreotide (brand name Somatuline). Octreotide comes in two forms, the first of which must be injected under the skin (subcutaneously) three times a day. Patients are given training to correctly inject themselves with this medication. The second form is longer-lasting (brand name Sandostatin LAR Depot) and is injected once a month deep into muscle (intramuscularly). A nurse usually performs the intramuscular injections.
Preoperative medical somatostatin analogue treatment will also be discussed. Malhotra et al (2017) noted that patients with implanted continuous, non-pulsatile, LVADs have increased the occurrence of GI bleeding (GIB). The effect of treatment on tumor shrinkage was affected by several different factors Table 4 Treatment resulted in significantly greater tumor shrinkage if 1) tumor dimensions were reported as volume rather than as a linear measurement (odds ratio OR: 2.73; 95% CI: 1.73-4.31; p<0.001); 2) patients had been treated with octreotide LAR rather than subcutaneous octreotide (OR: 3.18; 95% CI: 1.95-5.20); p<0.001); 3) patients had a treatment duration longer than 1 year as compared with a shorter treatment duration (OR: 1.90; 95% CI: 1.02-3.55; p = 0.043); or 4) patients had received octreotide as first-line therapy (OR increased according to the higher proportion of treatment-naïve patients: p<0.001).
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Acromegaly is most often caused by a benign pituitary adenoma and is characterized by clinical features including enlargement of the hands and feet, facial changes, hypertension, diabetes mellitus and cardiomyopathy. The electronic search identified 2202 articles. Of these, 41 studies fulfilling the eligibility criteria were selected for data extraction and analysis. In total, 1685 patients were included, ranging from 6 to 189 patients per trial. For the analysis of the effect of octreotide on pituitary tumor shrinkage a random effect model was used to account for differences in both effect size and sampling error.
Validating the presence of sst2 and sst5 on adenoma tissue has been suggested to allow the prediction of clinical efficacy of SRL. However immunohistochemical application for in vitro diagnostic has been hampered due to the lack of monoclonal and specific polyclonal anti-sst2 and sst5 antibodies. The use of two novel rabbit monoclonal anti-sst2A and anti-sst5 antibodies allowed for a several times more effective immunhistochemical staining for both, sst2A and sst5, respectively. Sst5 was seen in all, sst2 in 83% to 85% of the somatotropinomas.
Acromegaly may be treated by surgery to the pituitary gland to remove or reduce the size of the tumour, by radiotherapy, by drug treatment, or a combination of these. Nowadays, for many patients the first treatment is surgery, although in some centres drug treatment to reduce the size of the tumour is given first. The aim of all treatments is to reduce growth hormone and IGF-1 levels to normal, in order to improve the specific symptoms of acromegaly in addition to general well-being.
How To Increase HGH Levels Naturally
HGH or Human Growth Hormone is one of the most important hormones in the entire body, dictating many of our biological functions and influencing other hormones like testosterone and estrogen. As Sultan Kosen’s experience shows, radiation therapy is an alternative when patients don’t adequately respond to surgical and medical treatment. In recent years, stereotactic radiation, the most common of which is the Gamma Knife, has been making inroads to replace conventional fractionated radiation. Stereotactic radiation offers the advantage of a focused dose delivered to a limited area in a single operation. Fractionated radiation is delivered through each temple and the frontal area, exposing more areas of the brain to radiation, and is given repeatedly over a six-week period.
Increase in GH levels with PEG treatment. Baseline and follow up mean values with 95% confidence intervals reported in randomised 7 and non-randomised studies. The duration of treatment in the 5 phases of the Jorgensen study 19 was 2 to 4 weeks, 8 weeks, 6 weeks, 6 weeks and 12 weeks. Dose of PEG in the RCT extension 8 varied according to patient response. Figure compiled from published data 7 , 8 , 19 with the addition of 95% CI.
The majority of patients received their SRL injections at their general practitioner’s (GP’s) office or hospital outpatient clinic (68%), and in most cases, these were administered by the nurse or the physician (39 and 33% respectively). This was remarkably similar between the treatments, and only 17% of patients (16% of octreotide and 18% of lanreotide-receiving patients) reported that they received the injections at home. Only eight patients (10%) treated with lanreotide reported they were self-injecting their medication (2% on octreotide). Germany, UK and The Netherlands showed notable similarity regarding the above treatment patterns.
The study selection process is depicted in Figure 1 Electronic searches revealed 2202 articles, of which only 1547 were eligible for the screening. 1422 articles did not meet the eligibility criteria and were discarded. The full text of the remaining 125 studies was fully examined. After examination of the full text, 84 studies were excluded for the following reasons: 39 for reporting insufficient data, 30 because of a different study aim, 7 because they were not clinical trials, 6 because they included a mixed treatment population, 1 because patients were duplicated in another included study, and 1 because the report was preliminary.