***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To investigate whether 4-month preoperative lanreotide treatment would improve the surgical cure rate of newly diagnosed acromegalic patients with macroadenomas . DESIGN A prospect i ve , r and omised study . METHODS After a baseline evaluation , patients were r and omly assigned to 4-month preoperative treatment with lanreotide ( starting with 30 mg/2 weeks i.m . and increasing to 30 mg/week i.m . at week 8 if mean GH > 2.5 microg/l on GH day curves ; pretreatment group , Group 1 ) or to transsphenoidal surgery ( direct surgery group , Group 2 ) . Cure was evaluated 4 months postoperatively primarily by fasting IGF1 less than or equal to age-adjusted upper limit of normal . RESULTS A pool of 108 patients was r and omly divided into two groups . Five patients in each group were lost to follow-up during the study period , so 49 patients in each group were analysed . At baseline , no difference was observed between the two groups . Cure was established in 24 of 49 ( 49.0 % , 95 % confidence interval ( CI ) , 35.0 - 63.0 % ) pretreated patients ( Group 1 ) versus 9 of 49 ( 18.4 % , 95 % CI , 7.6 - 29.2 % ) direct surgery patients ( Group 2 ; P=0.001 ) . Surgical morbidity was recorded in 12 patients ( 12.2 % ) and was similar in Group 1 and 2 patients ( 14.3 and 10.2 % respectively ; P=0.538 ) . The postoperative hospital stay was similar between groups : being 4.5+/-1.6 days in Group 1 vs 4.8+/-1.9 days in Group 2 ( P=0.328 ) . CONCLUSIONS Pretreatment with lanreotide before transsphenoidal surgery improves surgical cure rates in patients with GH-secreting pituitary macroadenomas . Pretreatment does not affect surgical complications or duration of hospital stay ( Clinical Trials.gov number , NCT00993356 ) Objective Treatment with somatostatin analogues is the primary medical treatment of acromegaly . Controversies still exist whether acute octreotide effect predicts long‐term biochemical effects , tumour regression or surgical cure . This prospect i ve study investigates effect of 6‐month treatment with octreotide long‐acting repeatable ( LAR ) on insulin‐like growth factor‐1 ( IGF‐1 ) and growth hormone ( GH ) levels , pituitary function , tumour regression and postoperative cure in de novo acromegalic patients Ten patients with previously untreated acromegaly and invasive pituitary macroadenomas were treated with the long-acting somatostatin analog SMS 201 - 995 ( S and oz ) for 3 - 30 weeks before transsphenoidal or subfrontal pituitary adenomectomy . Preoperatively , treatment with SMS 201 - 995 reduced mean 24-h plasma GH concentrations from 8.5 - 66.7 to below 4.6 micrograms/L in eight patients and by 60 - 80 % in the remaining two patients . Pituitary tumor size decreased 20 - 54 % . Morphologically , the tumors showed decreased total cell , cytoplasmic , and nuclear areas ; varying degrees of perivascular fibrosis ; and dense granularity . Postoperatively , plasma GH and insulin-like growth factor I concentrations fell into the normal range , and GH dynamics became normal in eight patients . In the remaining two patients mild GH hypersecretion persisted after surgery ( mean fasting and r and om plasma GH , 6.1 and 7.9 micrograms/L ) , and in one of them GH secretion became normal 1 yr after pituitary irradiation . Thus , preoperative administration of SMS 201 - 995 consistently induced shrinkage of GH-producing pituitary tumors , and the apparent remission rate was high in the treated patients OBJECTIVE To investigate the possible impact of pretreatment with octreotide on different subtypes of GH-secreting pituitary adenomas and on the outcome of transnasal surgery . METHODS We review ed a consecutive series of 90 acromegalic patients treated with octreotide alone before transnasal surgery .  On the basis of magnetic resonance imaging , the tumours were classified into four groups : group A , microadenoma ( n=7 ) ; group B , transnasally resectable macroadenoma ( n=21 ) ; group C , invasive , potentially transnasally resectable macroadenoma ( n=43 ) ; group D , non-resectable grossly invasive macroadenoma ( n=19 ) . All patients were treated for at least 3 months before surgery , with a mean daily dose of 221+/-31 microg octreotide . The mean follow-up was 51.7+/-1.4 months . The comparative group included 57 acromegalic patients who were not receiving octreotide treatment . RESULTS After pretreatment with octreotide , tumour shrinkage was clearly observed in 28 of the 90 patients ( 31 % ) . At surgery , the tumours after octreotide treatment were more often white or grey in colour ( 91 % compared with 75 % ) and were observed to be slightly more often fluid or soft in texture ( 86 % compared with 79 % ) than those in the comparative series . Endocrinological remission was achieved in all patients in group A , 95.2 % in group B , and 81.4 % in group C. In only 10 of the 14 patients with tumour shrinkage in group C , endocrinological remission was also achieved ( 71.4 % ) . In the comparative series , endocrinological remission was achieved in 92.9 % of group A , 87.5 % of group B , and 73.9 % of group C. CONCLUSIONS Octreotide treatment slightly improved the already relatively high rate of endocrinological remission in invasive , potentially transnasally resectable macroadenomas . The rate of tumour shrinkage was found to decrease with extrasellar size . With the exception of tumour growth in approximately 7 % of invasive adenomas and pituitary apoplexy in one patient , there was no disadvantage associated with the octreotide pretreatment The somatostatin analog , octreotide , is an inhibitor of growth hormone ( GH ) secretion that has been used to treat patients with GH-producing pituitary tumors . In this study we investigated the in vivo responsiveness to treatment with this analog in patients harboring different morphological types of GH-producing pituitary adenomas . Both GH and insulin-like growth factor I ( IGF-I ) plasma levels in 30 patients treated with octreotide ( 300 micrograms/day ) for 4 months preoperatively were compared with those from 30 patients who did not receive treatment preoperatively . Tissue sample s were studied using ultrastructural and immunohistochemical techniques . Amongst patients harboring densely granulated ( DG ) adenomas , mean GH levels were reduced to 32 + /- 9 % by octreotide , to 30 + /- 7 % by surgery and to 26 + /- 9 % of baseline by both interventions . Surgery was equally as effective in lowering GH levels in patients with sparsely granulated ( SG ) adenomas as it was in those with DG adenomas ; in patients with SG adenomas , GH levels were reduced by surgery alone to 37 + /- 16 % and to 24 + /- 15 % when performed following octreotide pretreatment . In contrast , treatment with octreotide alone in patients harbouring SG adenomas reduced GH levels to only 70 + /- 13 % of baseline ( p < 0.02 compared to surgery alone , or surgery and octreotide ) . We conclude that the GH inhibitory effects of octreotide are significantly better in patients harboring DG somatotroph adenomas compared with those harboring SG adenomas One hundred seventy-two acromegalics who were operated on using the trans-sphenoidal approach underwent long-term follow-up evaluation . Sixty-four received 100 micrograms octreotide subcutaneously three times daily : for 3 to 6 weeks before surgery in 14 patients ( group 1 ) ; and for 3 to 9 months in 41 and for 13 to 39 months in nine ( n = 50 , group 2 ) . In 18 group 2 patients , the dose was increased stepwise to 500 micrograms three times daily because of incomplete suppression of growth hormone (GH)/insulin-like growth factor-1 ( IGF-1 ) . Tumor shrinkage was seen in 60 % within 3 weeks , being nearly maximal by 3 to 4 months . More group 2 patients had greater than 25 % tumor shrinkage ( 14 of 48 v 1 of 14 in group 1 ) . Clinical response was excellent or good in 89 % . Decrease in soft-tissue swelling and weight loss , and improved vitality , performance , carbohydrate metabolism , and cardiovascular function , facilitated anesthetic and surgical management ; tumor removal was easy in virtually all cases . In all 64 patients , GH levels decreased by > or = 50 % , and to < 2 micrograms/L in three of 14 patients initially and 25 of 50 patients after more prolonged treatment . IGF-1 levels decreased to normal in seven of 14 group 1 and 31 of 50 group 2 patients . Light and electron microscopy showed that adenomatous tissue exposed to octreotide had lysosomal accumulation , amyloid deposition , mild to moderate perivascular fibrosis , and moderate size reduction in both cytoplasmic and nuclear areas , with virtually no cellular complications . Remission with enclosed adenomas was greater ( p < .05 ) than for the 108 patients not treated with octreotide ; there was no difference for invasive adenomas . Octreotide use for 3 to 4 months before surgery can be recommended Summary Background . The effect of presurgical long-acting somatostatin analogue ( SSA ) treatment on operative outcome in acromegaly is as yet uncertain and long-term observations are lacking . We evaluated in an acromegaly case-control study the effect of octreotide pre-treatment on short- and long-term postoperative GH concentrations , pituitary function and glucose tolerance . Methods . 48 patients with a pituitary macro-adenoma – micro- and giant adenomas excluded – were evaluated . 24 patients received presurgical octreotide treatment ( secondary surgery , prospect ively studied ) . Another 24 thoroughly matched patients had been operated on without prior octreotide therapy  ( primary surgery , retrospective evaluation ) . No patient had received any other treatment prior to operation/octreotide . St and ardized testing was performed at diagnosis , following octreotide treatment , after surgery and then yearly for 10.3±0.9 yrs ( mean±SE , primary surgery ) and 4.1±0.6 yrs ( secondary surgery ) . Immediate and 4-year postoperative results were compared . All work-up was strictly identical in both groups , except for imaging techniques . “ Partial remission ” was defined as mean GH profile ( 6-h/7-point ) concentration < 2.5 µg/L , and “ complete remission ” as GH nadir < 1 µg/L during OGTT plus normal IGF-I concentration ( when available ) . Findings . The median profile GH ( µg/L ) values and the OGTT GH nadir values post-surgery ( 2.4/1.0 vs 1.8/0.7 , primary and secondary surgery , resp . ) as well as 4 yrs later ( 2.1/1.15 vs 2.3/0.8 ) were not significantly different between the groups . The 10-year results of the primary surgery group were not significantly different from its 4-year results . Subgroup analysis of pre-treated patients revealed no significant difference between those with and without tumour shrinkage , or between those with and without parasellar tumour extension . Postoperatively pituitary function was not significantly different between the groups . After 4-years the pituitary-adrenal axis was slightly more impaired in the secondary surgery group rather than following primary surgery , while the pituitary-gonadal axis was not different . Conclusion . Presurgical octreotide treatment has no significant short- or long-term beneficial effect on GH concentration or pituitary function Pretreatment with octreotide ( OCT ) in acromegaly has been reported to improve surgical outcome . The objective of this study was to analyze retrospectively the effects of a 3- to 6-month presurgical treatment with OCT in acromegalics focusing on electrocardiographic ( ECG ) records , blood pressure levels , glucose and lipid profile , tumor size and consistency , easy tumor removal at surgery , and morphological findings at pathology . Fifty-nine patients with acromegaly who were undergoing surgical treatment were studied r and omly before surgery ; 37 patients were untreated , and 22 were treated with OCT at doses ranging 150 - 600 micrograms/day for 3 - 6 months  . At study entry , untreated and OCT-treated patients had similar circulating GH and insulin-like growth factor I ( IGF-I ) , glucose , and cholesterol levels as well as prevalence of 
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Quality of evidence for no need of adjuvant postoperative treatment was moderate , but for improving quality of life was very low and for mortality was absent .
Conclusion Pre-SA increases the chance of biochemical control of acromegaly 3 months after TSS in patients harboring GH-secreting pituitary macroadenomas