Nuklearmedizin 1997; 36(04): 117-124
DOI: 10.1055/s-0038-1629870
Originalarbeiten — Original Articles
Schattauer GmbH

Prädiktion der pharmakologischen Wirkung von Octreotid bei Akromegalie mittels 111In-Pentetreotid-Szintigraphie und Berechnung eines hypophysären Uptake-Index

Prediction of the Pharmacological Effect of Octreotide in Acromegaly by Means of 111In-Pentetreotide Scintigraphy and Calculation of a Pituitary Uptake Index
R. Görges
1   Aus der Klinik mit Poliklinik für Nuklearmedizin, Deutschland
,
U. Cordes
1   Aus der Klinik mit Poliklinik für Nuklearmedizin, Deutschland
,
M. Engelbach
2   III. Medizinischen Klinik und Poliklinik (Endokrinologie), Deutschland
,
K. M. Bartelt
1   Aus der Klinik mit Poliklinik für Nuklearmedizin, Deutschland
,
G. Haberern
1   Aus der Klinik mit Poliklinik für Nuklearmedizin, Deutschland
,
O. Hey
3   Neurochirurgischen Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz sowie aus der ‘Arbeitsgemeinschaft Niedergelassener Endokrinologen (Mainz / Darmstadt), Deutschland
,
J. Beyer
2   III. Medizinischen Klinik und Poliklinik (Endokrinologie), Deutschland
,
A. Bockisch
1   Aus der Klinik mit Poliklinik für Nuklearmedizin, Deutschland
› Author Affiliations
Further Information

Publication History

Eingegangen: 14 October 1996

in revidierter Form: 18 November 1996

Publication Date:
04 February 2018 (online)

Zusammenfassung

Ziel: Ziel unserer prospektiven Studie war die optimierte Bestimmung des hypophysären Somatostatin-Rezeptorstatus in der 111 -In-Pentetreotid-Szintigraphie und der intraindividuelle Vergleich mit dem pharmakologischen Effekt von Octreotid bei florider Akromegalie. Methoden: Bei n = 22 Patienten mit Wachstumshormon-(GH)-sezernierendem Hypophysenadenom wurde eine 111-In-Pentetreotid-Szintigraphie durchgeführt und die spezifische Nuklidakkumulation in der Hypophysenregion (Auswertung sowohl visuell als auch semiquantitativ mittels ROI-Technik und Berechnung verschiedener Uptake-Indizes) mit dem akuten GH-Abfall nach 100 ug Octreotid s.c. (Octreotid-Akuttest) korreliert. Ergebnisse: Der von uns vorgeschlagene Uptake-Index (Quotient zirkuläre Hypophysen-ROI : irreguläre Zerebrum-ROl, jeweils cts/pixel nach Untergrund-Korrektur im sagittalen SPECT-Schnitt mit der maximalen Hypophysendarstellung 24 h p. i.) korreliert am besten mit dem pharmakologischen Effekt (akuter GH-Abfall) von Octreotid; seine obere Normgrenze liegt im Bereich von 3,5. Schlußfolgerungen: Da sich häufig auch die normale Hypophyse szintigraphisch darstellen läßt, ist die rein visuelle Abgrenzung zum pathologischen Rezeptorstatus manchmal uneindeutig. Ein mittels standardisierter ROI-Technik berechneter, hypophysärer Uptake-Index erleichert diese Abgrenzung und hilft so, mögliche Responder für eine Octreotid-Langzeittherapie zu selektieren.

Summary

Aim: The aim of our prospective study was to optimize the determination of the pituitary somatostatin receptor status by means of 111-ln-pentetreotide scintigraphy and to compare it intraindividually with the pharmacological effect of octreotide in active acromegaly. Methods: In n = 22 patients with growth hormone (GH) secreting pituitary adenoma, 111-ln-pentetreotide scintigraphy was performed, and the specific radionuclide accumulation in the pituitary area (evaluation visually as well as semiquantitatively by means of ROI technique and calculation of various uptake indices) was correlated with the acute drop of GH after administration of 100 ug octreotide s.c. (octreotide acute test). Results: The uptake index we propose (cts/pixel-ratio circular pituitary ROI : irregular cerebrum ROI after background correction in the sagittal SPECT slice with maximum pituitary uptake 24 h p. i.) correlates best with the pharmacological effect (acute decrease of G H levels) of octreotide; its upper normal limit amounts to 3.5. Conclusion: As often the normal pituitary gland can be visualized scintigraphically, the purely visual differentiation between a normal and a pathological receptor status sometimes is equivocal. A pituitary uptake index, calculated by means of a standardized ROI technique, facilitates this discrimination and so contributes to select possible responders for a treatment with octreotide.

 
  • LITERATUR

  • 1 Bajc M, Palmer J, Ohlsson T, Edenbrandt L. Distribution and dosimetry of 111-In-DT-PA-D-Phe-octreotide in man assessed by whole body scintigraphy. Acta Radiologica 1994; 35: 53-7.
  • 2 Becker W, Schrell U, Lohner W. et al. In-111-octreotide-SPECT in patients with brain and pituitary tumors. J Nucl Med 1993; 34: 37P (Abstract 140).
  • 3 Duet M, Mundler O, Ajzenberg C. et al. Somatostatin receptor imaging in non-functioning pituitary adenomas: value of an uptake index. Eur J Nucl Med 1994; 21: 647-50.
  • 4 Ezzat S, Horvath E, Harris HG, Kovacs K. Morphologic effects of octreotide on growth hormone-producing pituitary adenomas. J Clin Endocrinol Metab 1994; 79: 113-8.
  • 5 Ezzat S, Snyder PJ, Young WF. et al. Octreotide treatment of acromegaly - a randomized, multicenter study. Ann Intern Med 1992; 117: 711-8.
  • 6 Fahlbusch R, Giovanelli M, Buchfelder M, Losa M. et al. Advances in the medical and surgical treatment of pituitary adenomas: the role of long-acting somatostatin analogs. J Endocrinol Invest 1993; 16: 449-60.
  • 7 Flogstad AK, Halse J, Grass P. et al. A comparison of octreotide, bromocriptine, or a combination of both drugs in acromegaly. J Clin Endocrinol Metab 1994; 79: 461-5.
  • 8 Fredstorp L, Kutz K, Werner S. Treatment with octreotide and bromocriptine in patients with acromegaly: an open pharmacodynamic interaction study. Clin Endocrinol 1994; 41: 103-8.
  • 9 Görges R, Eißner D, Kahaly G. et al. Darstellung von Metastasen eines Schilddrüsenkarzinoms mittels 111-In-Pentetreotide-Szintigraphie. Nuklearmedizin 1995; 34: 165-9.
  • 10 Gupta P, Waxman A, Nguyen K. et al. Quantitative evaluation of Indium-111 (In-111) octreotide pituitary activity: comparison in patients with and without pituitary tumors. J Nucl Med 1995; 36: 15P-16P (Abstract 53).
  • 11 Haberern G, Gorges R, Bockisch A. Quantifizierung eines pathologischen Somatosta-tin-Rezeptorstatus im In-111-Pentetreotide- SPECT bei Hypophysentumoren. Nuklearmedizin 1995; 34: A159 (Abstract P 115).
  • 12 Krenning EP, Kwekkeboom DJ, Bakker WH. et al. Somatostatin receptor scintigraphy with [111In-DTPA-D-Phe1]- and [123I-Tyr3]-octreotide: the Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993; 20: 716-31.
  • 13 Lamberts SWJ, de Herder WW, Kwekkeboom DJ. et al. Current tools in the diagnosis of pituitary tumours. Acta Endocrinologica 1993; 129 Suppl. 1 6-12.
  • 14 Lamberts SWJ, Hofland U, de Herder WW. Octreotide and related somatostatin analogs in the diagnosis and treatment of pituitary disease and somatostatin receptor scintigraphy. Fontiers Neuroendocrinol 1993; 14: 27-55.
  • 15 Lamberts SWJ, Uitterlinden P, Schuijff PC, Klijn JGM. Therapy of acromegaly with Sandostatin: the predictive value of an acute test, the value of serum somatomedin-C measurements in dose adjustment and the definition of a biochemical cure. Clin Endocrinol 1988; 29: 411-20.
  • 16 Lastoria S, Colao A, Vergara E. et al. Indium-Ill octreotide uptake levels in pituitary adenomas to predict the responsiveness to chronic octreotide treatment. J Nucl Med 1994; 35: 166P (Abstract 668).
  • 17 van Liessum PA, Pieters GF, Smais AG. et al. Single-dose response study of the somatostatin analogue octreotide in acromegaly. Acta Endocrinologica 1989; 121: 714-20.
  • 18 Lucs-Morante T, Garcia-Uria J, Estrada J. et al. Treatment of invasive growth hormone pituitary adenomas with long-acting somatostatin analog SMS 201-995 before transsphenoidal surgery. J Neurosurg 1994; 81: 10-4.
  • 19 Maini CL, Sciuto R, Tofani A. et al. Somatostatin receptor imaging in CNS tumors using 111-In-octreotide. Nucl Med Commun 1995; 16: 756-66.
  • 20 Mehltretter G, Heinz S, Schopohl J. et al. Long-term treatment with SMS 201-995 in resistant acromegaly: effectiveness of high doses and continuous subcutaneous infusion. Klin Wochenschr 1991; 69: 83-90.
  • 21 Messerschmidt D, Fett U, Reichel M. et al. Somatostatin receptor scintigraphy and pituitary tumor volume, hormone concentration and response to octreotide scintigraphy. Exp Clin Endocrinol 1995; 103 (Suppl. 1): 56 (Abstract P56).
  • 22 Miller GM, Alexander JM, Bikkal HA. et al. Somatostatin receptor subtype gene expression in pituitary adenomas. J Clin Endocrinol Metab 1995; 80: 1386-92.
  • 23 Patel YC, Greenwood MT, Panetta R. et al. The somatostatin receptor family. Life Sci 1995; 57: 1249-65.
  • 24 Pinkert J, Oehme L, Franke WG, Gerbert B. Pituitary uptake index for semiquantitative determination of somatostatin receptors in adenomas. Eur J Nucl Med 1994; 21: 779 (Abstract 220).
  • 25 Plöckinger U, Reichel M, Fett U. et al. Preoperative octreotide treatment of growth hormone-secreting and clinically nonfunctioning pituitary macroadenomas: effect on tumor volume and lack of correlation with immunohistochemistry and somatostatin receptor scintigraphy. J Clin Endocrinol Metab 1994; 79: 1416-23.
  • 26 Possa M, Sara R, Ruffini L. et al. 111-In-pentetreotide scintigraphy in pituitary adenomas. Eur J Nucl Med 1994; 21: 764 (Abstract 159).
  • 27 Reubi JC, Landoldt AM. The growth hormone responses to octreotide in acromegaly correlate with adenoma somatostatin receptor status. J Clin Endocrinol Metab 1989; 68: 844-50.
  • 28 Schmidt K, Althoff PH, Harris A. et al. Langzeitbehandlung der Akromegalie mit dem Somatostatinanalogon Octreotid (Sandostatin). Zur prädiktiven Bedeutung von Akuttests. Medizinische Klinik 1990; 85: 700-6.
  • 29 Stevenaert A, Beckers A. Presurgical octreotide treatment in acromegaly. Acta Endocrinologica 1993; 129 Suppl. 1 18-20.
  • 30 Timsit J, Chanson P, Harris AG. et al. Short-term continuous infusion of octreotide in acromegaly. Pharmacokinetics and prediction of the response to long-term treatment. Horm Metab Res 1991; 23: 48-9.
  • 31 Ur E, Mather SJ, Bomanji J. et al. Pituitary imaging using a labelled somatostatin analogue in acromegaly. Clin Endocrinol 1992; 36: 147-50.
  • 32 Vance ML, Harris AG. Long-term treatment of 189 acromegalic patients with the somatostatin analog octreotide - results of the international multicenter acromegaly study group. Arch Intern Med 1991; 151: 1573-8.
  • 33 Verhoeff NPLG, Meylaerts SAG, Miedema AR. et al. Somatostatin receptor imaging in the pituitary using (In-lll-DTPA)-octreoti-de and high resolution brain SPECT. J Nucl Med 1993; 34: 41P-42P (Abstract 159).
  • 34 Wagenaar AH, Harris AG, van der Lely AJ, Lamberts SW. Dynamics of the acute effects of octreotide, bromocriptine and both drugs in combination on growth hormone secretion in acromegaly. Acta Endocrinologica 1991; 125: 637-42.