Large fat and skin necroses after deep subcutaneous injections of a slow-release somatostatin analogue in a woman with acromegaly.
OBJECTIVE
Somatostatin analogues are the most commonly used drugs for treatment of acromegaly. Known side effects include gastrointestinal reactions, cholelithiasis, effects on glucose metabolism, and mild reactions at injection sites. We report a patient who developed fat and skin necroses after injections of a depot somatostatin analogue.


METHODS
A woman with active acromegaly was given deep subcutaneous injections of an extended release formulation of lanreotide at alternate sides of the buttocks on three occasions over a ten week period. The regimen was then discontinued due to gastrointestinal complaints. One month later indurated subcutaneous nodules appeared at both sites. After another two months, the patient presented 10×10 cm lesions on the buttocks, with central erythematous zones and, at the site of two injections, a necrotic 5×3 cm ulcer. There were no signs of infection or systemic diseases. MRI revealed bilateral fat necroses. A month later, an ulcer developed at the second site. The ulcers were managed conservatively until clear demarcations were obtained, where after surgical revisions were performed. Eight months after the last injection, the wounds could be closed.


CONCLUSIONS
The fat and skin necroses represent a side-effect not previously described after deep subcutaneous injections. Possibly, the patient had an exceptional susceptibility to develop an inflammatory, foreign-body like reaction that hypothetically was aggravated by a sustained anti-angiogenic effect of the compound.
Department of Endocrinology, University Hospital, SE-205 02 Malmö, Sweden. pia.a.burman@skane.se
Pia
P
Burman
Jan
J
Besjakov
Tor
T
Svensjö
D000172:Acromegaly / Q000188:drug therapy*; D000369:Aged, 80 and over; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D005218:Fat Necrosis / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous / Q000009:adverse effects / Q000379:methods; D009336:Necrosis / Q000139:chemically induced; D010456:Peptides, Cyclic / Q000008:administration & dosage* / Q000009:adverse effects*; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D013004:Somatostatin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D003692:Delayed-Action Preparations; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin