Diabetic Diarrhea and Somatostatin

Tsai, Shih-Tzer; Vinik, Aaron I.; Brunner, John F.

doi:10.7326/0003-4819-104-6-894_1

Cited by 30 publications

(9 citation statements)

References 3 publications

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“…The resultant highvolume watery diarrhea is often refractory to therapy and disabling for patients. Octreotide and its newly introduced long-acting analogue Sandostatin LAR have been found to have beneficial effects in the management of refractory secretory diarrhea resulting from a diverse spectrum of pathologies, including diabetes (4,7,(12)(13)(14). Somatostatin analogues effectively control diarrhea and flushing in patients with neuroendocrine tumors, diarrhea associated with short bowel syndrome, ileostomy, and amyloidosis (4,6).…”

Section: Discussionmentioning

confidence: 99%

“…Conventional treatments comprise broad spectrum antibiotics, bile salt binders such as cholestyramine, and loperamide, which may attenuate aberrant motility. Increasingly, diabetic patients with persistent refractory diarrhea are being treated with the somatostatin analogue octreotide (4), which attenuates secretory diarrhea resulting from a broad spectrum of pathologies, including diabetes (5)(6)(7). Octreotide has also been reported to attenuate both postprandial and orthostatic hypotension, complicating autonomic failure (8 -11) via a mechanism that may involve a reduction of vasodilatory gut peptides.…”

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confidence: 99%

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Severe Hypertension Induced by the Long-Acting Somatostatin Analogue Sandostatin LAR in a Patient with Diabetic Autonomic Neuropathy

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Chey

Stevens

2000

The Journal of Clinical Endocrinology & Metabolism

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A 26-yr-old woman with type 1 diabetes and severe symptomatic autonomic neuropathy was treated with the long-acting somatostatin analogue Sandostatin LAR for intractable diarrhea. Her diarrhea had previously been successfully managed with three daily injections of octreotide without adverse consequences. She was given a single dose of Sandostatin LAR and within 2 weeks reported the development of increasingly frequent and severe headaches. Three weeks after the injection, she was admitted to hospital with severe hypertension, which eventually resolved with the administration of antihypertensive agents. No other underlying cause of the hypertension was discovered. Rechallenge of the patient with octreotide resulted in a transient hypertensive episode, which lasted 3 h. Severe hypertension, therefore, seems to be a possible adverse effect of treatment of diabetic diarrhea with somatostatin analogues, which should be used with great caution in subjects with severe autonomic dysfunction.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Severe Hypertension Induced by the Long-Acting Somatostatin Analogue Sandostatin LAR in a Patient with Diabetic Autonomic Neuropathy

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Chey

Stevens

2000

The Journal of Clinical Endocrinology & Metabolism

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“…No: 69/13, 06540 A. Ayrancı, Ankara, Turkey (Received for publication on Oct. 16,1996; accepted on May 12, 1997) Oxygen (O 2 ) was used to increase the intraluminal pressure. The O 2 source and pressure transducer were the other combined parts of the apparatus.…”

Section: Methodsmentioning

confidence: 99%

“…16 However, while the potent inhibitory properties of somatostatin and its analogues may be useful in certain clinical situations, it could be detrimental in others. In experimental models, the long-acting analogue, octreotide, has been shown to inhibit post-resection adaptation of the bowel 17,18 as well as hepatic regeneration following hepatic resection.…”

Section: Introductionmentioning

confidence: 99%

The adverse effects of octreotide on the healing of colonic anastomoses in rats

et al. 1998

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Octreotide, a long-acting somatostatin analogue, is widely used in gastrointestinal hypersecretory states and also for endocrine tumors in an attempt to inhibit the paracrine hormones. Although it is well known that octreotide inhibits trophic and anabolic hormones, no research has been conducted on its adverse effects on wound healing. In the present study, groups of rats were given 20 mcg/kg/day octreotide and 100 mg/kg/day hydrocortisone, the latter being the negative control group, starting 5 days preoperatively. The colonic anastomoses were assessed for healing on postoperative days (PODs) 5 and 8 by determining the bursting pressure of the anastomoses, performing histopathological analysis, and measuring the hydroxyproline content of the anastomotic tissues. Octreotide was found to affect anastomotic healing negatively on both PODs 5 and 8, but the negative effect of hydrocortisone was significant only on POD 8. No significant difference was found between the adverse effects of the two agents on POD 8. These findings indicated that octreotide has an adverse effect on the healing of colonic anastomoses in rats.

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“…The diarrhea, which had been refractory to other treatment regimens, improved with use ofSMS 201-995 and was still improved 18 months after initiation of treatment. Other case reports also show somatostatin analogues to be well tolerated.t9, 23 In addition to these specific treatments, general measures to control diarrhea should be implemented. Temporary starvation should be discouraged, since intestinal nutrients are needed to activate digestive enzymes and stimulate mucosal growth.…”

Section: Treatmentmentioning

confidence: 99%

Diabetic diarrhea

Beebe

Walley²

1992

Postgraduate Medicine

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Diarrhea is a common gastrointestinal problem in diabetes, and its prevalence has been underestimated. The cause of diabetic diarrhea is unknown, but it is probably related to gastrointestinal motility disturbances secondary to diabetic autonomic neuropathy. Other causes (especially primary malabsorption syndromes and islet cell tumors) must be excluded. Treatment of diabetic diarrhea is largely symptomatic and only moderately effective. Antidiarrheal agents may ameliorate acute episodes. Broad-spectrum antibiotics and clonidine hydrochloride (Catapres) have had some success in long-term control. Most recently, subcutaneous administration of somatostatin analogues has been shown to be helpful, the main side effects being drowsiness and vomiting.

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Diabetic Diarrhea and Somatostatin

Cited by 30 publications

References 3 publications

Severe Hypertension Induced by the Long-Acting Somatostatin Analogue Sandostatin LAR in a Patient with Diabetic Autonomic Neuropathy

Severe Hypertension Induced by the Long-Acting Somatostatin Analogue Sandostatin LAR in a Patient with Diabetic Autonomic Neuropathy

The adverse effects of octreotide on the healing of colonic anastomoses in rats

Diabetic diarrhea

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