About effectiveness of treatment by somatostatin analogues of patients with non-functional pituitary adenomas on the base of study of expression somatostatin receptor isoforms

The aim of study is to analyze the effectiveness of treatment by somatostatin analogues (Sandostatin-LAR) in patients with non-functional pituitary adenomas (NFPA) on the base of expression somatostatin receptor isoforms SSTR3 and SSTR5. Material and methods: А total of 272 patients with macro- and giant inactive pituitary adenomas based on the analysis of pro- (151 patients) and retrospective (121 patients) studies of the frequency of macro- and giant NFPA. According to the size of the pituitary adenoma, prospective patients (151 patients) were divided into 2 groups: Group 1 - patients with macro- NFPA - 55 people, Group 2 - patients with giant NFPA - 96 people. All patients underwent examinations, including examination of the fundus, measurement of visual fields every 3 months, studies of the levels of STH, IGF-1, LH, FSH, ACTH, TSH, prolactin, free thyroxine, cortisol, as well as immunohistochemical studies of operated patients.with determination of expression levels of Ki67, p53, expression somatostatin receptor isoforms SSTR3 and SSTR5. Results: It was established that in 10 (50%) of 20 patients examined by IHC, expression of SSTR3 and SSTR5 isoforms of somatostatin receptors was established. At the same time, in 3 (30%) of 10 patients after 3 months of treatment with Sandostatin-Lar, a reliable reduction in the volume of the pituitary tumor was noted, while in 5 (50%) stabilization of the process was noted, and in 2 (20%) a relapse of growth was observed. The clinical immunohistochemical study showed that patients with giant NFPA are recommended to undergo not only a study of Ki67 proliferation markers in the postoperative period; p53, but also the level of expression of somatostatin receptor isoforms SSTR3 and SSTR5 to justify further pathogenetic treatment with somatostatin analogues (Sandostatin-Lar). Conclusions: 1.Analysis of SSTR subtypes is an argument in favour of introduction of novel broad-spectrum SSA that may be more effective in the treatment of NFPA. 2. In 10 patients who received Sandostatin Lar therapy, 3 months after TPA, stable preservation of the average size of the pituitary gland is observed. While in the 2nd group - without Sandostatin Lar - a tendency towards tumor growth is observed (p<0.005).

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