OCTREOTIDE AND RELATED SOMATOSTATIN ANALOGS IN THE DIAGNOSIS AND TREATMENT OF PITUITARY DISEASE AND SOMATOSTATIN RECEPTOR SCINTIGRAPHY

Clinical introduction of octreotide, a long-acting somatostatin analog, has opened a new era in the medical therapy of patients with growth hormone (GH)- and thyroid-stimulating hormone (TSH)-secreting pituitary tumors. Good control of hormonal hypersecretion occurred in most patients, and tumor shrinkage has been observed in more than half of them. Octreotide therapy is of no value in most patients with Prolactin (PRL)- and adrenocorticotrophic (ACTH)-secreting pituitary tumors. However patients with Cushing's syndrome caused by ectopic ACTH secretion from a variety of endocrine tumors benefit from octreotide administration. In patients with visual disturbances related to chiasmal compression by nonfunctioning pituitary tumors, somatostatin analog administration has been reported to result in rapid improvement in visual acuity. This beneficial effect might not be related to a direct action of octreotide, but may reflect an effect on the retina and/or optic nerve. The presence of somatostatin receptors on a wide variety of pituitary tumors as well as on a number of parasellar tumors allows their in vivo visualization with radionucleotide-labelled somatostatin analogs. A positive scan in patients with GH- and TSH-secreting pituitary tumors is predictive of a good suppressive effect of octreotide on hormone release by these tumors. PRL- and ACTH-secreting pituitary adenomas cannot be visualized, but clinically nonfunctioning pituitary adenomas are visualized in 75% of cases with In-111-DTPA-octreotide. At present it is unclear whether this has consequences with regard to the medical treatment of these last group of patients. Somatostatin receptor scintigraphy can be successfully used in the differential diagnosis between pituitary hypersecretion of GH and/or ACTH and the ectopic secretion of growth hormone-releasing hormone (GHRH) and ACTH by peripherally localized endocrine tumors. Again the visualization of such tumors also predicts successful control of hormonal hypersecretion by octreotide.