The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly.

2.50
Hdl Handle:
http://hdl.handle.net/10541/72648
Title:
The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly.
Authors:
Pokrajac, Ana; Claridge, Andrew G; Shakoor, S K Abdul; Trainer, Peter J
Abstract:
In many centres, a test dose (TD) of octreotide is administered before commencing somatostatin analogue therapy (SAT), although the merits of this procedure are uncertain. We have analysed the value of the GH response to a TD in predicting the efficacy of subsequent SAT in 47 patients with acromegaly (25 male, median age 51 years, range 20-82). The primary goal of SAT was a mean GH of < 5 mU/l. Median baseline GH was 19.3 mU/l (2.2-233 mU/l) and with the TD fell by 78% (35-98%) to a nadir of 4.2 mU/l (< 0.3-85 mU/l). Optimal predictive power was observed when GH fell to < 5 mU/l after the TD. With this criterion, the TD had a positive predictive value (PPV) of achieving the primary goal on SAT of 82% and a negative predictive value (NPV) of 50%. However, baseline GH was also highly predictive of the likelihood of successful SAT (GH < 5 mU/l). The GH response to the TD had PPV of 83% and NPV of 61% of normalising IGF-I on SAT. In summary, baseline GH and nadir after a TD are highly predictive of a good response to SAT; however, a poor response to a TD does not exclude an optimal response to SAT. Furthermore, failure to achieve biochemical control does not equate to no benefit, as biochemical improvement was seen in every patient; therefore, no patient should be deprived of octreotide therapy because of the result of a TD. In conclusion, our data indicate that the octreotide TD has no place in selecting patients for SAT.
Affiliation:
Christie Hospital NHS Trust, Department of Endocrinology, Wilmslow Road, Withington, Manchester M20 4BX, UK.
Citation:
The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly. 2006, 154 (2):267-74 Eur. J. Endocrinol.
Journal:
European Journal of Endocrinology
Issue Date:
Feb-2006
URI:
http://hdl.handle.net/10541/72648
DOI:
10.1530/eje.1.02073
PubMed ID:
16452540
Type:
Article
Language:
en
ISSN:
0804-4643
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorPokrajac, Ana-
dc.contributor.authorClaridge, Andrew G-
dc.contributor.authorShakoor, S K Abdul-
dc.contributor.authorTrainer, Peter J-
dc.date.accessioned2009-07-06T16:42:01Z-
dc.date.available2009-07-06T16:42:01Z-
dc.date.issued2006-02-
dc.identifier.citationThe octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly. 2006, 154 (2):267-74 Eur. J. Endocrinol.en
dc.identifier.issn0804-4643-
dc.identifier.pmid16452540-
dc.identifier.doi10.1530/eje.1.02073-
dc.identifier.urihttp://hdl.handle.net/10541/72648-
dc.description.abstractIn many centres, a test dose (TD) of octreotide is administered before commencing somatostatin analogue therapy (SAT), although the merits of this procedure are uncertain. We have analysed the value of the GH response to a TD in predicting the efficacy of subsequent SAT in 47 patients with acromegaly (25 male, median age 51 years, range 20-82). The primary goal of SAT was a mean GH of < 5 mU/l. Median baseline GH was 19.3 mU/l (2.2-233 mU/l) and with the TD fell by 78% (35-98%) to a nadir of 4.2 mU/l (< 0.3-85 mU/l). Optimal predictive power was observed when GH fell to < 5 mU/l after the TD. With this criterion, the TD had a positive predictive value (PPV) of achieving the primary goal on SAT of 82% and a negative predictive value (NPV) of 50%. However, baseline GH was also highly predictive of the likelihood of successful SAT (GH < 5 mU/l). The GH response to the TD had PPV of 83% and NPV of 61% of normalising IGF-I on SAT. In summary, baseline GH and nadir after a TD are highly predictive of a good response to SAT; however, a poor response to a TD does not exclude an optimal response to SAT. Furthermore, failure to achieve biochemical control does not equate to no benefit, as biochemical improvement was seen in every patient; therefore, no patient should be deprived of octreotide therapy because of the result of a TD. In conclusion, our data indicate that the octreotide TD has no place in selecting patients for SAT.en
dc.language.isoenen
dc.subject.meshAcromegaly-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshDiagnostic Tests, Routine-
dc.subject.meshFemale-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.subject.meshInsulin-Like Growth Factor I-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshOctreotide-
dc.subject.meshPredictive Value of Tests-
dc.subject.meshSensitivity and Specificity-
dc.subject.meshStatistics, Nonparametric-
dc.titleThe octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly.en
dc.typeArticleen
dc.contributor.departmentChristie Hospital NHS Trust, Department of Endocrinology, Wilmslow Road, Withington, Manchester M20 4BX, UK.en
dc.identifier.journalEuropean Journal of Endocrinologyen

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