Effects of Octreotide on Lipid Metabolism in Acromegaly

Abstract

Hypertriglyceridemia is the most frequent modification of lipid metabolism observed in acromegaly. The somatostatin analog, octreotide (Sandostatin), widely used in the treatment of acromegaly, is able to produce a decrease in levels of growth hormone (GH), insulin, and Insulin-like Growth Factor 1 (IGF1). We have attempted to evaluate the influence of this treatment on the lipid status of acromegalic patients. Seventeen patients with active acromegaly were treated with octreotide, 100 to 500 micrograms/injection subcutaneously three times daily. The levels of fasting serum triglycerides (TG), total cholesterol, High Density Lipoprotein (HDL) cholesterol and IGF1, as well as mean plasma GH and insulin levels during a diurnal profile, were evaluated before and after three months of octreotide therapy. GH, insulin and IGF1 decreased by 61%, 42% and 36% respectively (p less than 0.05). Mean levels (+/- SEM) of TG and total cholesterol fell from 2.2 +/- 0.4 mmol/l to 1.6 +/- 0.3 mmol/l (p less than 0.05) and 6.4 +/- 0.39 mmol/l to 5.6 +/- 0.27 mmol/l (p greater than 0.05), respectively. There was no correlation between triglyceride decrease and hormonal changes or clinical status (BMI, age, sex). In conclusion, the administration of octreotide over a three month period to acromegalic patients is associated with a decrease in TG levels.

Different Effects of Continuous and Intermittent Patterns of Growth Hormone Administration on Lipoprotein Levels inGrowth Hormone-Deficient Patients

“…However, comparable results have recently been reported by a Swedish group using a similar study design of 2 weeks duration [27]. Acromegaly, another condition associated with increased total and in particular baseline GH levels, is also associated with elevated levels of Lp(a) [5]and other lipoproteins [33]. Even though the differences obtained seem to be quantitatively modest, they might be of importance following longer-term GH exposure.…”

Clinical indicators of biochemical remission in acromegaly: does incomplete disease control always mean therapeutic failure?

“…Concordant basal insulin levels and R HOMA index support this. Although the correction of hypersomatotropism was associated with a fall of basal insulin and insulin resistance estimated by R HOMA in our study, there was no significant change in otherwise normal levels of triglycerides as should be expected by some previous reports 46,47 . A favourable fall in IGF‐I, fasting insulin and insulin resistance accompanied by a decrease of free fatty acids and unchanged triglyceride levels can be seen in patients treated with pegvisomant 48,49 .…”

Cardiovascular Risk Factors in Acromegaly before and after Normalization of Serum IGF-I Levels with the GH Antagonist Pegvisomant

“…Total cholesterol levels in patients with acromegaly were previously reported to be either increased (12) or comparable (49) with levels in control subjects. Somatostatin analog therapy in acromegaly decreases triglyceride levels, but its impact upon cholesterol levels has been contradictory (9,13,50). Because a number of patients who participated in the present study had previously been treated with somatostatin analog therapies, it is impossible to rule out an effect of somatostatin analog withdrawal.…”

“…Patients with acromegaly have an increased prevalence of hypertension (6) and disturbances of intermediary metabolism, including insulin resistance and increased metabolic rate (7,8). Increased levels of triglycerides (9,10) and lipoprotein(a) (11) have been reported in acromegaly, whereas hypercholesterolemia has been inconsistently found (11)(12)(13). Therefore, GH hypersecretion may influence risk factors contributing to the increased cardiovascular morbidity associated with acromegaly.…”