Clinical Autonomic Research

, Volume 17, Issue 6, pp 334–340 | Cite as

Treatment of autonomic neuropathy, postural tachycardia and orthostatic syncope with octreotide LAR

  • Robert D. Hoeldtke
  • Kimberly D. Bryner
  • Martin E. Hoeldtke
  • Gerald Hobbs


The purpose of this study was to determine whether autonomic neuropathy and the postural tachycardia syndrome can be treated with octreotide LAR (Long Acting Release). This was an open-label pilot project. Protocol 1 Patients with autonomic neuropathy (n = 4) were given increasing doses of octreotide LAR once a month for three months. Blood pressure was measured in the sitting posture every two weeks. Pretreatment mean blood pressure averaged 83.8 ± 7.1 mm Hg. After four, six and eight weeks of therapy the blood pressures averaged 96.3 ± 6.4, 98.2 ± 6.1 (p < .025), and 104.1 ± 3.1 (p < .025) respectively. Therapy led to a dramatic improvement in symptoms in one patient but another had an unacceptable elevation in supine blood pressure. Protocol 2 Patients with POTS or orthostatic intolerance were given 10, 20, or 30 mg of octreotide LAR over three months. Seven patients entered and five completed the study. After two months treatment, standing time increased from 36.0 ± 9.2 to 59.2 ± .8 minutes (p < .01). Heart rate in the standing position was suppressed from 106 ± .83 to 93.2 ± .8 beats per minute (p < .05). Orthostatic dizziness and chronic fatigue improved. We conclude that octreotide LAR can be used to treat autonomic neuropathy but there is a risk of an excessive pressor response. Octreotide LAR improved standing time and suppressed tachycardia in patients with orthostatic intolerance.

Key words

postural tachycardia octreotide midodrine autonomic nervous system 


  1. 1.
    Benrud-Larson LM, Dewar MS, Sandroni P, Rummans TA, Haythornthwaite JA, Low PA (2002) Quality of life in patients with postural tachycardia syndrome. Mayo Clin Proc 77:531–537PubMedCrossRefGoogle Scholar
  2. 2.
    Escorsell A, Bandi JC, Andreu V, Moitinho E, Garcia-Pagan JC, Bosch J, Rodes J (2001) Desensitization to the effects of intravenous octreotide in cirrhotic patients with portal hypertension. Gastroenterology 120:161–169PubMedCrossRefGoogle Scholar
  3. 3.
    Fukuda K, Straus SE, Hickie I, Sharpe M, Dobbins JG, Komaroff A, for the International Chronic Fatigue Syndrome Study Group (1994) Chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 121:953–959PubMedGoogle Scholar
  4. 4.
    Hoeldtke RD, D’Dorisio TM, Boden G (1987) Treatment of autonomic neuropathy with a somatostatin analogue. Lancet II 602–605Google Scholar
  5. 5.
    Hoeldtke RD, David KM (1991) Orthostatic tachycardia syndrome: evaluation of autonomic function and treatment with octreotide and ergot alkaloids. J Clin Endo Metab 73:132–139CrossRefGoogle Scholar
  6. 6.
    Hoeldtke RD, Horvath GG, Bryner KD, Hobbs GR (1998) Treatment of orthostatic hypotension with midodrine and octreotide. J Clin Endo Metab 83:339–343CrossRefGoogle Scholar
  7. 7.
    Hoeldtke RD, Bryner KD, Hoeldtke M, Hobbs G (2006) Treatment of postural tachycardia syndrome: a comparison of octreotide and midodrine. Clin Auton Res 16:390–395PubMedCrossRefGoogle Scholar
  8. 8.
    Low PA, Gilden JL, Freeman R, Sheng K, McElligott MA (1997) Midodrine study group. Efficacy of midodrine vs. placebo in neurogenic orthostatic hypotension. JAMA 277:1046–1051PubMedCrossRefGoogle Scholar
  9. 9.
    Pop-Busui R, Chey W, Stevens MS (2000) Severe hypertension induced by the long-acting somatostatin analogue sandostatin LAR in a patient with diabetic autonomic neuropathy. J Clin Endo Metab 85:943–946CrossRefGoogle Scholar
  10. 10.
    Singer W, Sandroni P, Opfer-Gehrking TL, Suarez GA, Klein GM, Hines S, O’Brien PC, Slezak J, Low PA (2006) Pyridostigmine treatment trial in neurogenic orthostatic hypotension. Arch Neurol 63:513–518PubMedCrossRefGoogle Scholar
  11. 11.
    Sizer K (1999) Sandostatin LAR depot investigator’s brochure, Novartis Pharmaceuticals, Basel Switzerland, p 32Google Scholar
  12. 12.
    Stewart JM, McLeod KJ, Sanyal S, Herzberg G, Montgomery LD (2004) Relation of postural vasovagal syncope to splanchnic hypervolemia in adolescents. Circulation 100:2675Google Scholar
  13. 13.
    Stewart JM, Medow MS, Glover JL, Montgomery L (2006) Persistent splanchnic hyperemia during upright tilt in postural tachycardia syndrome. Am J Physiol Heart Circ Physiol 290:H665–H673PubMedCrossRefGoogle Scholar
  14. 14.
    Streeten DHP, Anderson GH (1992) Delayed orthostatic intolerance. Arch Intern Med 152:1066–1072PubMedCrossRefGoogle Scholar
  15. 15.
    Winer BJ (1979) Statistical principles and experimental design. 2nd ed. McGraw Hill, New York pp 309–603Google Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • Robert D. Hoeldtke
    • 1
  • Kimberly D. Bryner
    • 1
  • Martin E. Hoeldtke
    • 1
  • Gerald Hobbs
    • 2
  1. 1.Dept. of MedicineWest Virginia UniversityMorgantownUSA
  2. 2.Dept. of Community Medicine and StatisticsWest Virginia UniversityMorgantownUSA

Personalised recommendations