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[Treatment of carcinoid syndrome with a somatostatin analogue]
Z Döbrönte1, A Stöckert, G Végh
1Vas Megyei Markusovszky Kórház, Szombathely.
Abstract:
Octreotide, a long-acting somatostatin analogue has recently been introduced in the therapy of gastroenteropancreatic endocrine tumors, but home experience has been lacking. With the aim of drawing attention to this therapeutic possibility, a case of malignant carcinoid syndrome treated with octreotide for 18 months is reported. Despite the therapeutic attempts preceding the octreotide administration a gradual progression in clinical symptoms was observed and cardiac failure due to fibrotic and valvular heart disease developed. Cytotoxic chemotherapy, serotonin antagonists or repeated selective embolisation of the hepatic artery only resulted in a short transitional improvement. Octreotide in a dose of 100 micrograms three times daily by subcutaneous injection provided effective and rapid relief from episodic flushing and serious diarrhoea. Plasma level of serotonin and 24-hour urinary excretion of 5-hydroxyindolacetic acid decreased from 6 micrograms/ml to 2 micrograms/ml and from 800 mumol/day to 70 mumol/day, respectively. No changes in the number and extension of liver metastases could be seen after introducing the octreotide treatment. The patient's compensated cardiac status could be preserved and continuous therapy provided an acceptable quality of life.
Insights
Octreotide effectively managed malignant carcinoid syndrome symptoms, including flushing and diarrhea, in a long-term patient case. This somatostatin analogue treatment preserved cardiac status and improved quality of life.
Area of Science:
- Endocrinology
- Oncology
- Pharmacology
Background:
- Gastroenteropancreatic endocrine tumors (GEP-NETs) present therapeutic challenges.
- Limited clinical experience exists for octreotide in managing carcinoid syndrome within a domestic setting.
- Malignant carcinoid syndrome can lead to severe symptoms and cardiac complications.
Observation:
- A patient with malignant carcinoid syndrome experienced progressive symptoms despite prior treatments.
- Cardiac failure developed due to fibrotic and valvular heart disease.
- Previous therapies including chemotherapy, serotonin antagonists, and hepatic artery embolization offered only transient relief.
Findings:
- Octreotide, administered subcutaneously at 100 micrograms three times daily, rapidly alleviated flushing and diarrhea.
- Serotonin plasma levels decreased from 6 µg/ml to 2 µg/ml.
- 24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion reduced from 800 µmol/day to 70 µmol/day.
- Octreotide treatment did not alter the extent of liver metastases.
- The patient's cardiac status remained compensated, and quality of life was maintained.
Implications:
- Octreotide is a viable therapeutic option for malignant carcinoid syndrome, offering symptomatic relief and improved quality of life.
- Long-term octreotide therapy can effectively manage debilitating symptoms of carcinoid syndrome.
- This case highlights the importance of considering somatostatin analogues in advanced GEP-NETs, even with cardiac involvement.