Acromegaly Presenting with Diabetic Ketoacidosis, Associated with Retinitis Pigmentosa and Octreotide-Induced Bradycardia: A Case Report and A Review of the Literature
23
Citation
27
Reference
10
Related Paper
Citation Trend
Keywords:
Diabetic ketoacidosis
Ketoacidosis
Diabetic ketoacidosis
Ketoacidosis
Pasireotide
Cite
Citations (7)
Summary Diabetes in acromegaly is usually non-insulin dependent and is secondary to insulin resistance caused by growth hormone excess. Diabetic ketoacidosis is a result of relative insulin deficiency and is a rare feature of acromegaly. We describe a case of acromegaly presenting with diabetic ketoacidosis. We demonstrate that growth hormone excess can cause diabetic ketoacidosis in the presence of relative, but not absolute insulin deficiency.
Diabetic ketoacidosis
Ketoacidosis
Cite
Citations (39)
Abstract The case of a 30‐year‐old woman presenting with diabetic ketoacidosis as a first manifestation of acromegaly is reported. This is an extremely rare and unusual presentation. The case illustrates the importance of insulin resistance due to growth hormone excess in the presence of relative insulin deficiency as a cause of diabetic ketoacidosis. Copyright © 2004 John Wiley & Sons, Ltd.
Diabetic ketoacidosis
Ketoacidosis
Presentation (obstetrics)
Cite
Citations (1)
Octreotide has dramatically changed the results of medical treatment of acromegaly. It is the reference drug for the pharmacological treatment of acromegaly, owing to its impressive efficacy in suppressing growth hormome secretion, and excellent compliance. Safe growth hormone and normal insulin-like growth factor I values are reached in 50-60% of unselected patients. Octreotide arrests the growth of the tumor and shrinks tumor in over half of all patients (namely, up to 88% of naive patients and to complete disappearance in anecdotic cases). The safety profile of octreotide is excellent, but in some patients, glucose metabolism worsens and cholelythiasis occurs. This review will address the primary treatment and the relative roles of pharmacological and surgical treatment, as well as the predictivity of octreotide results.
Medical treatment
Cite
Citations (13)
Editorials1 February 1990Octreotide Is Effective in Acromegaly But Often Results in CholelithiasisWilliam H. Daughaday, MDWilliam H. Daughaday, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-3-159 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn this issue, Ho and colleagues (1) summarize their considerable experience in treating acromegaly with the long-acting somatostatin analog, octreotide. This agent has a much longer biologic half-life than somatostatin and its effects persist from 4 to 8 hours. Ho and colleagues found that when octreotide was administered twice a day, little additional benefit was gained by increasing each dose from 100 to 500 μg. Serum growth hormone (GH) was lowered more successfully with three doses a day but little benefit was added by increasing the amount of each dose from 100 to 500 μg. Some patients are resistant to...References1. HoWeissbergerMarbachLazarus KAPL. Therapeutic efficacy of the somatostatin analog SMS 201-995 (octreotide) in acromegaly: effects of dose and frequency and long-term safety. Ann Intern Med. 1990;112:173-181. LinkGoogle Scholar2. ReubiLandolt JA. The growth hormone responses to octreotide in acromegaly correlated with adenoma somatostatin receptor status. J Clin Endocrinol Metab. 1989;68:844-50. CrossrefMedlineGoogle Scholar3. QuabbePlöckinger HU. Dose-response study and long term effect of the somatostatin analog octreotide in patients with therapy-resistant acromegaly. J Clin Endocrinol Metab. 1989;68:873-81. CrossrefMedlineGoogle Scholar4. ChristensenWeekeOrskov SJH. Continuous subcutaneous pump infusion of somatostatin analogue SMS 201-995 versus subcutaneous injection schedule in acromegalic patients. Clin Endrocrinol (Oxf). 1987;27:297-306. CrossrefMedlineGoogle Scholar5. TauberBabinTauber JTM. Long term effects of continuous subcutaneous infustion of the somatostatin analog octreotide in the treatment of acromegaly. J Clin Endocrinol Metab. 1989;68:917-24. CrossrefMedlineGoogle Scholar6. JamesWhiteMollerChatterjeeHallKendall-Taylor RMNSKP. Continuous infusion of octreotide in acromegaly. Lancet. 1989;2:1083-7. CrossrefMedlineGoogle Scholar7. ZadikChalewMcCarterMeistasKowarski ZSRMA. The influence of age on the 24-hour integrated concentration of growth hormone in normal individuals. J Clin Endocrinol Metab. 1985;60:513-6. CrossrefMedlineGoogle Scholar8. ImuraKatoIshikawa HYE. Growth hormone secretion in acromegaly. In: Robbins, Melmed S, eds. Acromegaly: A Century of Scientific and Clinical Progress. New York: Plenum Press; 1987:83-95. CrossrefGoogle Scholar9. ClemmonsVan WykRidgwayKlimanKjellbergUnderwood DJEBRL. Evaluation of acromegaly by radioimmunoassay of somatomedin-C. N Engl J Med. 1979;310:1138-42. CrossrefGoogle Scholar10. BarkanBeitinsKelch AIR. Plasma insulin-like growth factor-I/somatomedin-C in acromegaly: correlation with the degree of growth hormone hypersecretion. J Clin Endocrinol Metab. 1988;67:69-73. CrossrefMedlineGoogle Scholar11. DaughadayTrivediWinnYan WBHH. Hypersomatotropism in pregnant women, as measured by a human liver radioreceptor assay. J Clin Endocrinol Metab. 1990; [In press]. CrossrefGoogle Scholar12. LembckeCreutzfeldtSchleserEbertShayKoop BWSRCI. Effect of the somatostatin analogue sandostatin (SMS 201-995) on gastrointestinal, pancreatic and biliary function and hormone release in normal men. Digestion. 1987;36:108-24. CrossrefMedlineGoogle Scholar13. FisherRockLevinMalmud REGL. Effects of somatostatin on gallbladder emptying. Gastroenterology. 1987;92:885-90. CrossrefMedlineGoogle Scholar14. MarteauChretienCalmusParcPoupon PYYRR. Pharmacological effects of somatostatin on bile secretion in man. Digestion. 1989;42:16-21. CrossrefMedlineGoogle Scholar15. BodenShimoyama GR. Somatostatinoma. In: Cohen S, Soloway RD, eds. Hormone-Producing Tumors of the Gastrointestinal Tract. New York: Churchill Livingstone; 1985:85-99. Google Scholar16. Comi R. Pharmacology and use in pituitary tumors. In: Gorden P, moderator. Somatostatin and somatostatin analogue (SMS 201-995) in treatment of hormone-secreting tumors of the pituitary and gastrointestinal tract and non-neoplastic diseases of the gut. Ann Intern Med. 1989;110:35-50. MedlineGoogle Scholar17. JacksonBarnardLamberton ILP. Role of the long-acting somatostatin analogue (SMS 201-995) in the treatment of acromegaly. Am J Med. 1986;81(Suppl 6B): 94-101. CrossrefMedlineGoogle Scholar18. McKnightMcCanceAtkinsonCrothers JDAJ. Changes in glucoase tolerance and development of gall stones during high dose treatment with octreotide for acromegaly. Br Med J. 1989;299:604-5. CrossrefMedlineGoogle Scholar19. WassAndersonBesserDowling JJGR. Gall stones and treatment with octreotide for acromegaly [Letter]. Br Med J. 1989;299:1162-3. CrossrefGoogle Scholar20. BuscailTauberPuel-Bosquet LJC. Gallstones and treatment with octreotide for acromegaly [Letter]. Br Med J. 1989;299:1162. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Washington University School of Medicine St. Louis, Missouri PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByProphylactic Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Does Not Increase Postoperative MorbidityCholelithiasis and acromegaly: therapeutic strategiesUse of octreotide acetate for control of symptoms in patients with islet cell tumorsEffect of chronic octreotide treatment on intestinal absorption in patients with acromegalyGallstones during octreotide therapyLiving with AcromegalyA prospective examination of octreotide-induced gall-bladder changes in acromegalyTherapeutic Use of Somatostatin and Octreotide Acetate in Neuroendocrine TumorsMicrovillus inclusion diseaseMicrovillus inclusion diseaseMiscellaneous hormones 1 February 1990Volume 112, Issue 3Page: 159-160KeywordsAcromegalyBiologicsCholelithiasisGrowth hormoneHalf lifeSomatostatin Issue Published: 1 February 1990 PDF DownloadLoading ...
Somatostatin Analogue
Pasireotide
Cite
Citations (13)
Twenty-one patients with active acromegaly and two patients with pituitary gigantism were treated with the long-acting somatostatin analogue octreotide (100-600μg/day, sc, two or three times daily or 300-1500μg daily by intermittent sc infusion) for 9-63 months. There was rapid clinical improvement. The fasting plasma GH levels were significantly suppressed (less than 50% of the values before treatment) in 17 patients and were normalized (less than 5ng/ml) in 6 patients (27.3%). Plasma IGF-I levels were lowered by 50% and were normalized in 7 out of 18 cases. The effect of octreotide on pituitary tumor size was evaluated in 13 patients. In 4 cases, the shrinkage of the pituitary tumor was detected by computed tomographic scans and/or magnetic resonance imaging studies. The drug was generally well tolerated. However, there were probably newly formed gallstones in two patients during the therapy. Our study suggests that octreotide is an effective and relatively safe new approach for treating active acromegaly and gigantism.
Gigantism
Cite
Citations (2)
Abstract Background: Octreotide has been successfully used for the treatment of acromegaly, but little long‐term data are available. Aims: To determine the long‐term efficacy and safety of octreotide in the treatment of acromegaly. Methods: Twenty‐seven patients with acromegaly were treated with octreotide in a non randomised study. Six patients had not had previous surgery or radiotherapy, and were treated with octreotide alone. Symptoms of acromegaly, IGF‐I levels, growth hormone suppression by glucose, pituitary tumour size, and side effects were monitored. The median duration of treatment was 44 months (range six‐102). Results: Symptom control was excellent. Twenty (74%) patients had a reduction of IGF‐I into the normal range. IGF‐I levels fell after one year from 94.2±6.1 nmol/L (mean±SEM) to 50.0±2.7 nmol/L ( p <0.0001). Ten of 13 (77%) patients had normal IGF‐I levels after four years. These reductions have persisted for up to nine years of octreotide therapy. The GH response to glucose was normalised in 14 of 16 (88%) subjects. Eleven of 25 (44%) patients had a reduction in pituitary gland height. Side effects were common, but usually of a minor nature. Cholelithiasis occurred in 39% of patients. Two patients ceased octreotide because of side effects. Conclusions: We conclude that octreotide is an effective and safe long‐term treatment for acromegaly. It is a useful adjunct to surgery, and may be offered as sole therapy for patients with smaller adenomas.
Cite
Citations (11)
Octreotide, an analog of somatostatin, is a valid tool for the cure of acromegalic disease. This compound has a prolonged half-life and is more selective than native somatostatin in suppressing growth hormone (GH) secretion. Octreotide, 100 micrograms tid sc, decreases GH levels and improves clinical symptoms in about 85% of acromegalic patients, lowering GH to below 5 ng/ml in 45% and to below 2 ng/ml in 17-21%. Octreotide normalizes somatomedin-C (IGF-I) levels in 36-50% of patients. The increase of dosage up to 1500 micrograms/day does not appear useful in poor responsive patients. No adverse effects on other endocrine functions submitted to hypothalamus-pituitary control have been observed. A slight shrinkage of the pituitary tumor is observed in 30-50% of cases. Octreotide therapy is well tolerated and side effects are usually mild. However the possibility of colelithiasis, liver damage and diabetes mellitus in patients with glucose intolerance must be taken into account. In conclusion octreotide is a useful complement to therapeutic means now used for the treatment of acromegaly.
Cite
Citations (0)
The somatostatin analogue octreotide has been proven to be safe and effective in treatment of acromegaly. It is now in discussion as the primary therapy in some patients. However, data on long-term effectiveness and safety for more than 10 years are still limited until now.
Somatostatin Analogue
Cite
Citations (0)
Treatment modalities for acromegaly include transsphenoidal surgery, medical therapy, and radiotherapy. Somatostatin analogs are the medical therapy of choice in acromegaly, with octreotide long-acting repeatable (LAR) the current global leader for patients with growth hormone (GH)-secreting pituitary adenomas. In patients with acromegaly, octreotide LAR is traditionally used as postsurgical therapy in patients with persistent disease. Although surgery remains the first-line treatment option in patients with tumors likely to be completely resected, there is a growing consensus that octreotide LAR could be used as first-line therapy in select patients. Octreotide LAR has been used in the treatment of acromegaly for over 10 years, and there are a wealth of data demonstrating that it is an effective, convenient, and well-tolerated treatment for the majority of patients with this disorder. Most patients initiating treatment with somatostatin analogs begin with octreotide LAR 20 mg every 28 days. On average, 60% of patients can safely achieve normal GH and insulin-like growth factor-I levels during octreotide LAR therapy, as well as experience significant reduction in pituitary tumor volume. However, recent studies have shown that up to 80% of patients can attain biochemical control. This can be attained by regularly monitoring GH and insulin-like growth factor-I levels and by escalating the dose of octreotide LAR to 30 mg or 40 mg every 28 days. By optimizing the control of acromegaly, the comorbidities and increased risk of premature mortality associated with this disorder can be reversed in most patients.
Pasireotide
Transsphenoidal surgery
Cite
Citations (6)