title: Severe and prolonged hypoglycemia triggered by long-acting octreotide in a patient with malignant mesenchymal tumor: case report.
abstract: Somatostatin analogues are potent growth hormone and glucagon inhibitors and are commonly used in the treatment of several endocrine and non-endocrine disorders. We report severe and longstanding hypoglycemia triggered by long-acting octreotide (Sandostatin LAR) in a 62-year-old women with malignant mesenchymal tumor. Hypoglycemia developed after 6 hours of octreotide injection and she was admitted to the emergency unit with sweating, tremor, palpitation and confusion. On admission, her plasma glucose level was: 17 mg/dl (normal: 65-110), cortisol: 31 microg/dl (normal: 5-25), insulin: 4.32 microIU/ml (normal: 6-27), C-peptide: 2.64 ng/ml (normal: 0.9-4.0), growth hormone: 0.06 ng/ml (normal: 0.06-5.0), insulin-like growth factor-I: 8.5 ng/ml (normal: 101-303), insulin-like growth factor binding protein-3: 1715 ng/ml (normal: 2020-3990). Intravenous dextrose infusion was given for a month to sustain normoglycemia since hypoglycemia recurred following cessation of infusion. Therefore, prednisolone, 35 mg/day was added and the parenteral dextrose infusion rate was decreased gradually and finally stopped. Normoglycemia could be maintained with prednisolone 20 mg/day. In patients prone to tumor hypoglycemia, long-acting octreotide may trigger severe and prolonged hypoglycemia due to suppression of counter-regulatory hormones; clinical trial with short-acting octreotide may be warranted to predict and prevent this life-threating complication.
authors.affiliation: Akdeniz University, School of Medicine, Department of Internal Medicine, Division of Endocrinology, Antalya, Turkey. drsari@hotmail.com
authors.forename: R
authors.initials: R
authors.lastname: Sari
authors.forename: H
authors.initials: H
authors.lastname: Altunbas
authors.forename: M
authors.initials: M
authors.lastname: Ozdogan
authors.forename: E I
authors.initials: EI
authors.lastname: Gurer
authors.forename: U
authors.initials: U
authors.lastname: Karayalcin
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D008648:Mesoderm / Q000473:pathology; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D015282:Octreotide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D005938:Glucocorticoids; D011239:Prednisolone; D015282:Octreotide