Dependency and analgesia related to treatment with subcutaneous octreotide in patients with growth hormone-secreting tumors.
OBJECTIVE
To describe three patients diagnosed with somatotropinomas in whom the analgesic effect of octreotide was observed, along with dependency to the drug.


METHODS
These patients had pituitary macroadenomas treated with transphenoidal surgery and pituitary radiotherapy, and received high daily doses (>900 microg/day) of subcutaneous octreotide because of persistent high levels of growth hormone and insulin-like growth factor I (IGF-I).


RESULTS
Headache occurred prior to drug administration in all three cases, with relief soon after. We also observed tolerance to octreotide's analgesic and anti-secretory actions (one patient), craving for the drug (two patients), withdrawal syndrome (one patient), and drug abuse (one patient).


CONCLUSIONS
Dependency syndrome may occur when high doses of octreotide are used, sometimes leading to drug abuse. Tolerance to the growth hormone anti-secretory effect of the drug may encourage physicians to increase doses to levels at which drug dependency has been observed. Sustained release somatostatin analogs may represent a solution to this problem.
Donangelo
Ines
I
Endocrinology Unit, Internal Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro.
Rodacki
Melanie
M
Peixoto
Maria Cláudia
MC
Vaisman
Mario
M
Caldas
Nelson R
NR
Gadelha
Mônica R
MR
D000236:Adenoma / Q000188:drug therapy* / Q000378:metabolism* / Q000532:radiotherapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004361:Drug Tolerance; D005260:Female; D019382:Human Growth Hormone / Q000378:metabolism*; D006801:Humans; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects* / Q000627:therapeutic use; D010911:Pituitary Neoplasms / Q000188:drug therapy* / Q000378:metabolism* / Q000532:radiotherapy / Q000601:surgery; D019966:Substance-Related Disorders
D018931:Antineoplastic Agents, Hormonal; D019382:Human Growth Hormone; D015282:Octreotide