title: Is there a role for somatostatin and its analogs in Cushing's syndrome?
abstract: The effects of somatostatin and its analogs have been studied in different subclasses of patients with Cushing's syndrome (due to Cushing's disease, ectopic corticotropin [ACTH]- and/or corticotropin-releasing hormone [CRH]-secreting tumors, or ACTH-independent Cushing's syndrome) and in patients with Nelson's syndrome. In most patients with untreated Cushing's disease, octreotide does not suppress ACTH release, a finding that is supported by in vitro studies. However, octreotide or somatostatin inhibits pathological ACTH secretion in Nelson's syndrome. Short-term octreotide treatment has caused a significant initial response (decreased serum cortisol, ACTH, and cortisoluria) in 24 of 38 (64%) patients with ectopic ACTH/CRH Cushing's syndrome, and long-term treatment caused a persistent response in 10 of 14 (71%) cases. Pentetreotide scintigraphy may help to identify those patients with ectopic ACTH/CRH tumors who will have an initial response to octreotide, and is useful for locating ectopic ACTH/CRH-secreting tumors and their metastases. To date, octreotide has been shown to temporarily suppress gastric inhibitory peptide (GIP)-induced cortisol secretion in GIP-dependent (ACTH-independent) Cushing's syndrome, but has not shown any therapeutic benefit in other forms of ACTH-independent Cushing's syndrome.
authors.affiliation: Department of Internal Medicine III, University Hospital Rotterdam, The Netherlands.
authors.forename: W W
authors.initials: WW
authors.lastname: de Herder
authors.forename: S W
authors.initials: SW
authors.lastname: Lamberts
mesh_terms: D003480:Cushing Syndrome / Q000145:classification / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007205:Indium Radioisotopes; D015282:Octreotide / Q000627:therapeutic use; D011877:Radionuclide Imaging; D013004:Somatostatin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D007205:Indium Radioisotopes; D013004:Somatostatin; C081788:pentetreotide; D015282:Octreotide