Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review

Acromegaly is a rare disease with a multifaceted clinical presentation. In 90–95% of patients with acromegaly, the disease is caused by a growth hormone (GH)-secreting pituitary adenoma with elevated GH levels that ultimately induce excessive hepatic secretion of insulin-like growth factor-1 (IGF-1). Somatostatin receptor ligands (SRLs) are considered the standard medical choice for the treatment of acromegaly, and normalization of GH and IGF-1 is attainable with effective therapy. This review aims to summarize the literature relative to SRL dose escalation therapy in patients with acromegaly. A United States National Library of Medicine PubMed search of SRL’s was conducted using the following search terms: ((((LAR) OR ATG) OR octreotide) OR lanreotide Autogel) AND acromegaly. Related articles in non peer-reviewed journals were excluded. The rationale and benefits of SRL dose optimization therapy were investigated with emphasis on describing the clinical recognition, treatment, and management of patients with acromegaly. We found that dose escalation could provide additional biochemical control of acromegaly in patients who are inadequately controlled with conventional starting doses of octreotide LAR and lanreotide Autogel®. Furthermore, patients should routinely have their GH and IGF-1 levels closely monitored and their SRL dose increased or decreased thereafter according to individual response

Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options

Konservering av et 1700-talls lerretsmaleri : overmalinger som får bli

Utgangspunktet for masterprosjektet var et oljemaleri på lerret, Maria bebudelse (91 x 74 cm, registreringsnr. 3989). Maleriet har et religiøst motiv, og kan opprinnelig ha vært ment som kirkekunst. Motivet skildrer en tradisjonell bebudelsesscene der Jomfru Maria mottar budskapet om unnfangelsen av erkeengelen Gabriel. Hendelsen bevitnes av tre småengler som tumler rundt i skyene. Kunstneren av Maria bebudelse var ukjent. Maria bebudelse har vært i Glomdalsmuseets eie i ukjent tid, antageligvis fra begynnelsen av 1900- tallet, og har hittil aldri vært utstilt på museet. Det var lite som var kjent ved maleriets historie, og datering og proveniens var ukjent. På grunnlag av den kulturhistorisk analyse av maleriet, var det sannsynlig at maleriet hadde en opprinnelse fra 1700- tallet, og at det mest sannsynlig ikke var av norsk herkomst. Maleriet var i en dårlig tilstand da det ankom konserveringsstudiet våren 2007. Lerretet var svært nedbrutt, og var ikke et stabilt underlag for malingslaget. Gjennom lokale behandlinger av rifter og hull, og forsterkning av sprukne oppspenningskanter med en kantdublering, ble den strukturelle integriteten gjeninnført. Maleriet hadde vært behandlet på en måte som avspeilet en typisk tidlig konserveringspraksis, der store partier av overflaten var blitt overmalt. Etter nærmere undersøkelser ble det klart at overmalingene var påført for å fremheve det kunstneriske uttrykket, og de var utført på en estetisk tilfredsstillende måte. Med utgangspunkt i flere argumenter, ble det derfor besluttet å bevare dem. Summary The artwork which my masters thesis discusses, is an oil painting on canvas entitled The annunciation of the Virgin Mary (74 x 91 cm, registration nr. 3989). The painting is endowed with a religious motif and could perhaps originally have been intended as church art. The motif depicts a traditional annunciation scene where the Virgin Mary receives notice of the imminent immaculate conception from the archangel Gabriel. The event is witnessed by three small angels that romp around in the clouds above. The Artist of The annunciation of the Virgin Mary is not known. The painting has been in the care of the Glomdal museum in Norway since the beginning of the twentieth century, yet has never thus far been displayed. There is very little historical knowledge accompanying this painting. The date of its creation and even its provenance are unknown. Artistic analyses of the paintings motif suggests that it emanates from the eighteenth century and that it is most likely not from Norway. The painting was in a neglected condition when it arrived at the study for conservation (IAKH) in january of 2007. The canvas was severely decomposed and was not a stable base for the paintlayers. The painting has been treated in a way which reflected typical earlier conservation practices where large parts of the surface have been painted over. After closer research was conducted it became apparent that the areas of overpaints had been applied in order to emphasize the artistic expression and that was performed in an aesthetically satisfactory way. For several reasons it was decided to keep the overpaints

Efficacy of the new long-acting formulation of lanreotide (lanreotide Autogel) in the management of acromegaly.

Lanreotide Autogel is a new long-acting aqueous preparation of lanreotide for the treatment of acromegaly and is administered by deep sc injection from a small volume, prefilled syringe. The aim of this study was to evaluate the efficacy and safety of this new long-acting formulation in a large population of acromegalic patients previously responsive to lanreotide 30 mg, im (sustained release microparticle formulation). Lanreotide Autogel was administered by deep sc injection every 28 d to 107 patients (54 males and 53 females; mean age, 54 +/- 1.2 yr). All patients had been treated with lanreotide (30 mg) for at least 3 months before study entry and had a mean GH level less than 10 ng/ml after at least 4 subsequent im injections every 14 d (48%), 10 d (32%), or 7 d (20%). Treatment was switched from lanreotide 30 mg injected every 14, 10, or 7 d to 60, 90, or 120 mg lanreotide Autogel, respectively, every 28 d. After three fixed dose injections of lanreotide Autogel, mean lanreotide levels were similar to those obtained at steady state with lanreotide 30 mg. During lanreotide Autogel treatment, the control of acromegalic symptoms was comparable with that previously achieved during lanreotide 30 mg treatment. After 3 injections of lanreotide Autogel, mean GH (2.87 +/- 0.22 ng/ml) and IGF-I (317 +/- 15 ng/ml) values were comparable with those recorded at the end of lanreotide 30 mg treatment (GH, 2.82 +/- 0.19 ng/ml; IGF-I, 323 +/- 16 ng/ml). GH levels below 2.5 ng/ml and age-/sex-normalized IGF-I were achieved in 33% and 39% of patients during lanreotide 30 mg and lanreotide Autogel treatment, respectively. Diarrhea, abdominal pain, and nausea were reported by 38%, 22%, and 18% of patients during lanreotide 30 mg treatment and by 29%, 17%, and 9% of patients, respectively, during lanreotide Autogel treatment. In conclusion, this clinical study shows that lanreotide Autogel is at least as efficacious and well tolerated as lanreotide 30 mg. This new long-acting lanreotide formulation, lanreotide Autogel, which is administered from a small volume, prefilled syringe by deep sc injection, is therefore likely to improve the acceptability of medical treatment for patients requiring long-term somatostatin analog therapy