Octreotide
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Reactions 1259 - 4 Jul 2009 S Octreotide Severe and prolonged hypoglycaemia: case report A 53-year-old woman receiving octreotide for neuroendocrine carcinoma developed severe and prolonged hypoglycaemia. She later died. Following diagnosis of unresectable pancreatic cancer with multiple metastases in the liver lung and spleen, the woman started treatment with SC interferon-α-2b and SC octreotide [Sandostatin] 0.1mg three times daily. One month later, a long-lasting release formulation of octreotide [Sandostatin LAR] was substituted for the short-acting analogue; she received 20mg once monthly. Ten days after her second injection of Sandostatin LAR, she was admitted following loss of consciousness. Laboratory investigations revealed a plasma glucose level of 14 mg/dL (normal 70–110). The woman immediately received bolus IV dextrose, followed by a dextrose infusion. Her mental status slowly improved over 30 minutes and her plasma glucose level rose to 75 mg/dL. Despite adequate oral nutrition, her hypoglycaemia recurred after stopping the dextrose infusion and the infusion was continued for a further 6 weeks. Methylprednisolone was started and the dextrose infusion was tapered off. She remained euglycaemic and was discharged. Home blood glucose monitoring showed she maintained normal plasma glucose levels. Methylprednisolone was gradually tapered and stopped 8 weeks postdischarge. Four months postadmission she was admitted after losing consciousness. Her plasma glucose level was 12 mg/dL and an IV dextrose infusion was started. A CT scan revealed significant disease progression. The dextrose infusion was continued until her death. Author comment: "[I]t is possible that overproduction of [high-molecular-weight insulin-like growth factor-II] by the tumor in combination with octreotide might play a role in the onset of hypoglycemia in the presence of decreased hepatic glucose output associated with tumor destruction of the liver and increased glucose consumption by the tumor". Unek IT, et al. Hypoglycemia induced by long-acting somatostatin analogues in a patient with nonfunctional neuroendocrine tumor. Journal of B. U. ON: Official Journal of the Balkan Union of Oncology 14: 135-138, No. 1, Jan-Mar 2009 - Turkey 801141500 1 Reactions 4 Jul 2009 No. 1259 0114-9954/10/1259-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Octreotide
Reactions 1259 - 4 Jul 2009
SOctreotide
Severe and prolonged hypoglycaemia: casereport
A 53-year-old woman receiving octreotide forneuroendocrine carcinoma developed severe andprolonged hypoglycaemia. She later died.
Following diagnosis of unresectable pancreatic cancerwith multiple metastases in the liver lung and spleen, thewoman started treatment with SC interferon-α-2b and SCoctreotide [Sandostatin] 0.1mg three times daily. Onemonth later, a long-lasting release formulation of octreotide[Sandostatin LAR] was substituted for the short-actinganalogue; she received 20mg once monthly. Ten days afterher second injection of Sandostatin LAR, she was admittedfollowing loss of consciousness. Laboratory investigationsrevealed a plasma glucose level of 14 mg/dL (normal70–110).
The woman immediately received bolus IV dextrose,followed by a dextrose infusion. Her mental status slowlyimproved over 30 minutes and her plasma glucose levelrose to 75 mg/dL. Despite adequate oral nutrition, herhypoglycaemia recurred after stopping the dextroseinfusion and the infusion was continued for a further6 weeks. Methylprednisolone was started and the dextroseinfusion was tapered off. She remained euglycaemic andwas discharged. Home blood glucose monitoring showedshe maintained normal plasma glucose levels.Methylprednisolone was gradually tapered and stopped8 weeks postdischarge. Four months postadmission shewas admitted after losing consciousness. Her plasmaglucose level was 12 mg/dL and an IV dextrose infusion wasstarted. A CT scan revealed significant disease progression.The dextrose infusion was continued until her death.
Author comment: "[I]t is possible that overproduction of[high-molecular-weight insulin-like growth factor-II] by thetumor in combination with octreotide might play a role inthe onset of hypoglycemia in the presence of decreasedhepatic glucose output associated with tumor destruction ofthe liver and increased glucose consumption by the tumor".Unek IT, et al. Hypoglycemia induced by long-acting somatostatin analogues in apatient with nonfunctional neuroendocrine tumor. Journal of B. U. ON: OfficialJournal of the Balkan Union of Oncology 14: 135-138, No. 1, Jan-Mar 2009 -Turkey 801141500
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Reactions 4 Jul 2009 No. 12590114-9954/10/1259-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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