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

Abstract

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.

Efficacy of octreotide but not long‐acting somatostatin analogue for severe refractory diabetic diarrhoea

“…Lanreotide was ceased and octreotide recommenced. In contrast to a previous case report [6], the long‐acting somatostatin analogue was not associated with development of hypertension.…”

“…Where other causes have been excluded, severe diarrhoea in patients with poorly controlled Type 1 diabetes mellitus is thought to be as a result of bowel dysmotility caused by autonomic dysfunction, although other mechanisms may contribute. The literature on management of severe diabetic diarrhoea includes a limited number of case reports of successful treatment with somatostatin analogues [1–7]. Two cases have been reported where octreotide‐responsive patients were switched to therapy with long‐acting somatostatin analogues: in one patient, this treatment was successful [7] but, in the other, the long‐acting analogue was associated with development of severe hypertension [6].…”

“…The literature on management of severe diabetic diarrhoea includes a limited number of case reports of successful treatment with somatostatin analogues [1–7]. Two cases have been reported where octreotide‐responsive patients were switched to therapy with long‐acting somatostatin analogues: in one patient, this treatment was successful [7] but, in the other, the long‐acting analogue was associated with development of severe hypertension [6]. The mechanisms of action of somatostatin analogues in treating diarrhoea include inhibition of intestinal (especially small bowel) motility, inhibition of release of gut peptides and effects on splanchnic blood flow (reviewed by Farthing [8]).…”

Marked improvement in cardiovascular function after successful transsphenoidal surgery in acromegalic patients

“…A normal BP circadian rhythm after surgery may represent a marker of reduced cardiovascular risk in these patients, even in presence of hypertension. On the other hand, vasoactive effects of somatostatin analogues, involving a reduction of vasodilatory gut peptides, have been well‐documented in subjects with autonomic failure and especially with diabetic autonomic failure (Dudl et al ., 1987; Pop‐Bosui et al . 2000), but have not been reported in acromegalic patients until a recent observation of an increase in 24‐h and nocturnal BP values in 10 patients after a 6‐month period of octreotide treatment (Fallo et al ., 1998).…”

Treatment of autonomic neuropathy, postural tachycardia and orthostatic syncope with octreotide LAR

“…We could not find a single dose response schedule that appeared safe for all participants. Patients 1 and 2, for example, showed a good response to 10-20 mg but we were afraid the 30 mg dose would lead to an excessive pressor response [9]. Patients 3 and 4, by contrast showed no response to 10 and 20 mg doses, and, therefore, were administered 30 mg.…”