Dramatic improvement of severe dilated cardiomyopathy in an acromegalic patient after treatment with octreotide and trans-sphenoidal surgery

Abstract

Severe congestive heart failure developed in an acromegalic patient, and was successfully treated with octreotide followed by trans-sphenoidal surgery. Clinical, hormonal echocardiographic and haemodynamic findings as well as histological heart examination before and after treatment revealed that over-production of growth hormone may induce the myocardial cell degeneration responsible for mechanical heart dysfunction. In addition, this unique example demonstrates the reversibility of myocardial damage following octreotide and trans-sphenoidal surgery, leading to significant improvement in cardiac function with minimal diastolic dysfunction and moderate interstitial fibrosis.

Histopathological Improvement of Acromegalic Cardiomyopathy by Intermittent Subcutaneous Infusion of Octreotide.

“…It is hypothesized, however, that the indirect action could account for the beneficial effect because successful surgery also reversed histological abnormalities in the reported case [7]. On the other hand, it is on the same lines as the report of Legrand et al [8] …”

“…Some cases of acromegalic cardiomyopathy are resistant to conventional cardioactive medication [4,5]. It has been demonstrated that octreotide was effective for acromegalic cardiomyopathy [6][7][8], but there have been conflicting reports indicating that acromegalic congestive heart failure could be worsened by octreotide through a negative inotopic action of somatostatin [9][10][11]. and inspiratory crackles were audible at lung bases.…”

“…Legrand et al [8] reported that myocardial degeneration was improved in an acromegalic patient associated with severe dilated cardiomyopathy following treatment with transsphenoidal surgery in combination with octreotide.…”

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…385,403,404 The increased prevalence of LV hypertrophy in patients with hypertension and glucose tolerance abnormalities emphasizes the need for optimal control of blood pressure and hyperglycemia together with efficacious suppression of GH and IGF-1 levels. 401 Although a case report of severe congestive HF from acromegalic cardiomyopathy suggests that cardiac function could be recovered significantly and that LV mass could be decreased with transsphenoidal surgery and administration of octreotide, 405 other reports suggest that these beneficial effects appear earlier in young patients with short disease duration than in elderly patients. 401 Some reports indicate that the treatment of acromegaly might improve cardiac function in the short term, but the long-term prognosis is questionable.…”

Improvement of Cardiac Function after Treatment with Octreotide followed by Trans-sphenoidal Surgery in an Acromegalic Patient who Presented with Congestive Heart Failure.

“…8,19,20) Treatment with somatostatin analogs has proved effective for acromegalics, even in those with advanced cardiac failure. 17,21,22) While others have observed worsening of congestive heart failure with octreotide, 23,24) Chanson, et al reported that a very low LVEF (<20%) might increase the risk of precipitating cardiac failure with octreotide, since this somatostatin analog exerts a negative inotropic effect by decreasing GH. 25) In the present patient, left ventricular ejection fraction increased from 11% to 27% after treatment with octreotide, then it further increased to 43% after trans-sphenoidal surgery.…”