Growth Progression and 24-Hour Hormone Profile in an Infant Treated Chronically with a Long-Acting Somatostatin Derivative

Abstract

The diagnosis of nesidioblastosis was established in a 9-month-old male child with a history of recurrent convulsive seizures and hypoglycemia. After unsuccessful subtotal pancreatectomy, treatment was started with the long-acting somatostatin derivative Sandostatin® (Octreotide, Sandoz) at a dosage of 25 µg t.i.d. spaced between carbohydrate-enriched meals. With this regime, blood glucose was maintained at the low normal range and seizures ceased. During a 30-month observation period, growth velocity and weight progression were well within the predicted limits. A 24-hour hormone profile recorded at the end of the observation period revealed the following: (1) failure to improve blood glucose with carbohydrate-enriched food due to reactive hyperinsulinemia; (2) hyperglycemic reaction after administration of Sandostatin caused by a reduction of plasma insulin; this effect was particularly marked during sleep; (3) low mean GH, decreased spiking frequency and reduced area covered by the nocturnal peaks by recognized standards, and (4) normal somatomedin C levels for age. Interpretation of growth hormone (GH) data is hindered by the lack of pertinent information from the patient’s age group. Recording of normal growth progression in the case illustrated here can only be explained by the capability of a reduced GH secretory rate to maintain full biological activity as shown by the normal plasma level of somatomedin C. Indeed, recent evidence has been provided elsewhere for normal growth progression in the presence of low GH secretion, although other factors unrelated to this hormone may also be operative at this early age. Further reports concerning the treatment of non-GH-dependent conditions with somatostatin derivatives will certainly contribute to the better understanding of the mechanisms governing growth in the postnatal period.

Normal Growth after Administration of Octreotide: Report on a Case of Persistent Hyperinsulinemic Hypoglycemia of Infancy Treated by Continuous Subcutaneous Injection of Octreotide

“…Diazoxide can suppress hyperinsulinemia but has serious side effects [3]. Successful treatment with octreotide, a long-acting somatostatin analogue, was reported but it involves the possibility of suppresion of GH [4][5][6]. Here we report a case of persistent hyperinsulinemic hypoglycemia in a male infant who was treated by continuous subcutaneous injection of octreotide for 4 months, and on the course of his growth and development.…”