Suppression of ectopic adrenocorticotropin secretion by the long-acting somatostatin analog octreotide.
The long-acting somatostatin analog (octreotide) was administered to a 37-yr-old woman with the ectopic ACTH syndrome. The patient had diffuse metastatic spread of a nonpituitary tumor, presumably of pancreatic origin, and severe and rapidly progressive hypercortisolism with extreme myopathy, hypokalemia, and diabetes mellitus. Plasma ACTH and lipotropin levels and 24-h urinary cortisol excretion were greatly elevated [218 pg/mL (48 pmol/L), 1340 pg/mL (220 pmol/L), and up to 830 micrograms/24 h (2290 nmol/day), respectively]. Urinary cortisol excretion decreased to normal within 3 days after the initiation of octreotide therapy (150, 300, and 600 micrograms/day), and plasma ACTH and lipotropin levels also decreased. Urinary cortisol excretion remained normal for 2 months during chronic octreotide therapy, and her general condition improved dramatically. The only side-effect was a slight increase in the number of bowel movements. Tumor progression, however, was not controlled, and she eventually died of hepatic insufficiency. These data indicate that octreotide can be a highly effective treatment for patients with the ectopic ACTH syndrome.
Bertagna
X
X
Department of Internal Medicine, Hôpital Cochin, Paris, France.
Favrod-Coune
C
C
Escourolle
H
H
Beuzeboc
P
P
Christoforov
B
B
Girard
F
F
Luton
J P
JP
D000182:ACTH Syndrome, Ectopic / Q000188:drug therapy* / Q000378:metabolism; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D005260:Female; D005755:Gastrins / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D009382:Neoplasms, Unknown Primary / Q000188:drug therapy* / Q000378:metabolism; D015282:Octreotide / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000378:metabolism; D009384:Paraneoplastic Endocrine Syndromes / Q000188:drug therapy*; D012463:Saliva / Q000378:metabolism; D013004:Somatostatin / Q000031:analogs & derivatives*; D008083:beta-Lipotropin / Q000097:blood
D005755:Gastrins; D013004:Somatostatin; D000324:Adrenocorticotropic Hormone; D008083:beta-Lipotropin; D015282:Octreotide; D006854:Hydrocortisone