The octreotide test dose is not a reliable predictor of the subsequent response to somatostatin analogue therapy in patients with acromegaly.
AffiliationChristie Hospital NHS Trust, Department of Endocrinology, Wilmslow Road, Withington, Manchester M20 4BX, UK.
MetadataShow full item record
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.
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.
JournalEuropean Journal of Endocrinology
- The value of an acute octreotide suppression test in predicting long-term responses to depot somatostatin analogues in patients with active acromegaly.
- Authors: Karavitaki N, Botusan I, Radian S, Coculescu M, Turner HE, Wass JA
- Issue date: 2005 Mar
- Intravenous octreotide test predicts the long term outcome of treatment with octreotide-long-acting repeatable in active acromegaly.
- Authors: Biermasz NR, Pereira AM, Smit JW, Romijn JA, Roelfsema F
- Issue date: 2005 Jun
- The nadir growth hormone after an octreotide test dose predicts the long-term efficacy of somatostatin analogue therapy in acromegaly.
- Authors: Gilbert JA, Miell JP, Chambers SM, McGregor AM, Aylwin SJ
- Issue date: 2005 Jun
- Poor responses to a test dose of subcutaneous octreotide predict the need for adjuvant therapy to achieve 'safe' growth hormone levels.
- Authors: Lindsay JR, McConnell EM, Hunter SJ, McCance DR, Sheridan B, Atkinson AB
- Issue date: 2004
- Limited predictive value of an acute test with subcutaneous octreotide for long-term IGF-I normalization with Sandostatin LAR in acromegaly.
- Authors: de Herder WW, Taal HR, Uitterlinden P, Feelders RA, Janssen JA, van der Lely AJ
- Issue date: 2005 Jul