Deterioration of Glycemic Control during Octreotide LAR Treatment in an Acromegalic Japanese Patient with Type 2 Diabetes Mellitus

Abstract

Abstract. We report a case showing deterioration of glycemic control during octreotide long-acting release (LAR) treatment in an acromegalic Japanese patient with type 2 diabetes mellitus. The patient did not show much improvement of insulin sensitivity (QUICKI; 0.33 before treatment, 0.35 during octreotide LAR treatment), and showed a significant reduction in early insulin secretion (insulinogenic index; 0.28 before treatment, 0.08 during octreotide LAR treatment) on 75 g oral glucose tolerance test (75gOGTT), despite decreases in GH and IGF-I levels during the course of octreotide LAR treatment. Postoperatively, both insulin sensitivity and early insulin secretion on 75gOGTT were improved (QUICKI 0.59, insulinogenic index 0.35). There are some reports that insulinogenic index is lower in most Japanese patients with type 2 diabetes mellitus and that early insulin secretions are significantly suppressed after administration of octreotide LAR. Although the influence of octreotide LAR on glucose metabolism varies among individuals, it is necessary to manage the deterioration of glucose tolerance during octreotide LAR treatment in acromegalic Japanese patients with decreased insulinogenic index. CHRONIC growth hormone (GH) excess seems to induce a reduction of insulin sensitivity and worsening of glucose intolerance [1], and approximately 20% of acromegalic patients have diabetes mellitus [2]. Both marked improvements in insulin resistance and reduction of glycosylated hemoglobin (HbA1c) were reported to accompany postoperative decreases in GH level in these patients [3]. Although octreotide, which is the therapeutic agent used in the treatment of acromegaly, gradually reduces the GH level [4], it also inhibits the secretions of insulin, glucagon and other intestinal hormones. Furthermore, octreotide delays gastrointestinal movement, which leads to a decrease in glucose absorption [5]. Thus, these effects of octreotide are known to influence glucose metabolism, and the changes in glucose tolerance in acromegalic patients receiving octreotide treatment vary with the individual. Here, we report an acromegalic patient showing deterioration of glucose tolerance during treatment with octreotide long-acting release (LAR), which was well tolerated and reduced mean 24-hour GH levels as effectively as multiple daily subcutaneous injections of octreotide [6], and glucose tolerance without octreotide improved following surgery for pituitary tumor. Case ReportA 46-year-old woman was admitted to our hospital for a work-up for diabetes mellitus in July 2004. Her father also had diabetes mellitus. On physical examination, her body mass index (BMI) was 20.7 kg/m 2 , blood pressure was 130/80 mmHg, and she showed acromegalic facies. Laboratory examinations were

Diabetic ketoacidosis in a patient with acromegaly and central diabetes insipidus treated with octreotide long-acting release

“…However, predicting the onset of DM in acromegalic patients during somatostatin analog therapy remained difficult because of the diversity of insulin resistance/secretion in individuals. Kahara et al reported that a patient with octreotide LAR did not show an improvement in insulin sensitivity (QUICKI: 0.33 before treatment, 0.35 during octreotide LAR treatment) but did exhibit a reduction in insulin secretion (insulinogenic index: 0.28 before treatment, 0.08 during octreotide LAR treatment) [9]. The current patient exhibited IGT before octreotide LAR treatment and had a lower QUICKI than the patient in the study of Kahara et al, suggesting insulin resistance.…”