Abstract
The adverse gastrointestinal effects of octreotide, a synthetic analog of somatostatin, have not been fully elucidated. Low-dose octreotide frequently causes adverse gastrointestinal symptoms in normal individuals. We investigated the adverse gastrointestinal effects of high-dose octreotide, which is required for the normalization of growth hormone hypersecretion in some patients with acromegaly. Patients with acromegaly (N=8) were treated with octreotide, 450 μg/day, then 1500 μg/day for two months at each dosage. Carbohydrate absorption was assessed using thed-xylose test, and fat absorption using fecal fat excretion and serum carotene concentrations, at baseline, at each dosage of octreotide, and after one month of washout. Ultrasonography was used to monitor for cholelithiasis. Growth hormone and insulin-like growth factor-I concentrations were significantly suppressed at both dosages. Adverse gastrointestinal symptoms were mild and transient.d-Xylose absorption remained normal at each dosage and after one month of washout. Fecal fat excretion increased from 7±2 to 12±2 g/24 hr (P<0.05) after the higher dosage and resumed baseline levels after the washout. Mean fasting serum carotene levels remained normal, and carotene loading test (15,000 units three times a day for three days) was unreliable in identifying patients with high fecal fat. No new cholelithiasis was detected by ultrasonography. One of two patients with preexisting cholelithiasis developed biliary colic several days after the treatment period. Although steatorrhea was common, small intestinal absorptive capacity was otherwise unchanged by four months of high-dose octreotide treatment, which significantly suppressed growth hormone secretion in acromegalic patients.
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References
Reichlin S: Somatostatin. N Engl J Med 309:1495–1501, 1983
Reichlin S: Somatostatin (second of two parts). N Engl J Med 309:1556–1563, 1983
Barkan AL, Kelch RP, Hopwood NJ, et al: Treatment of acromegaly with the long-acting somatostatin analog SMS 201-995. J Clin Endocrinol Metab 66:16–23, 1988
Gorden P, Comi RJ, Maton PN, et al: NIH conference. Somatostatin and somatostatin analogue (SMS 201-995) in treatment of hormone-secreting tumors of the pituitary and gastrointestinal tract and non-neoplastic diseases of the gut. Ann Intern Med 110:35–50, 1989
Lembcke B, Creutzfeldt W, Schleser S, et al: Effect of the somatostatin analogue sandostatin (SMS 201-995) on gastrointestinal, pancreatic and biliary function and hormone release in normal men. Digestion 36:108–124, 1987
Harris GJ, Tio F, Cruz ABJ: Somatostatinoma: A case report and review of the literature. J Surg Oncol 36:8–16, 1987
Furlanetto RW, Underwood LE, Van Wyk JJ, et al: Estimation of somatomedin-C levels in normals and patients with pituitary disease by radioimmunoassay. J Clin Invest 60:648–657, 1977
Van de Kamer JH: Total Fatty Acids in Stool. New York, Academic Press, 1958, pp 34–39
Ellefson RD, Caraway WT: Lipids and Lipoproteins. Philadelphia, WB Saunders Co., 1976, pp 474–541
Schalch DS, Parker ML: A sensitive double antibody immunoassay for human growth hormone in plasma. Nature 203:1141–1142, 1964
Roe JH, Rice EW: A photometric method for the determination of free pentoses in animal tissues. J Biol Chem 173:507–512, 1948
Sobel AE, Snow SD: The estimation of serum vitamin A with activated glycerol dischlorohydrin. J Biol Chem 171:617–632, 1947
Battershill PE, Clissold SP: Octreotide. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in conditions associated with excessive peptide secretion. Drugs 38:658–702, 1989
Lyles KW, Drezner MK: Diseases of Abnormal Phosphate Metabolism. Philadelphia, Lippincott, 1990, pp 523–531
Gertner JM, Tamborlane WV, Hintz RL, et al: The effects on mineral metabolism of overnight growth hormone infusion in growth hormone deficiency. J Clin Endocrinol Metab 53:818–822, 1981
Rolston DDK, Mathan VI: Xylose transport in the human jejunum. Dig Dis Sci 34:553–558, 1989
Jackson IM, Barnard LB, Lamberton P: Role of a long-acting somatostatin analogue (SMS 201-995) in the treatment of acromegaly. Am J Med 81:94–101, 1986
McGregor AR, Troughton WD, Donald RA, et al: Effect of the somatostatin analogue SMS 201-995 on faecal fat excretion in acromegaly. Horm Metab Res 22:55–56, 1990
Onstad GR, Zieve L: Carotene absorption. A screening test for steatorrhea. JAMA 221:677–679, 1972
Hopman WP, van Liessum PA, Pieters GF, et al: Pancreatic exocrine and gallbladder function during long-term treatment with octreotide (SMS 201-995). Digestion 45(suppl 1):72–76, 1990
Magnusson I, Einarsson K, Angelin B, et al: Effects of somatostatin on hepatic bile formation. Gastroenterology 96:206–212, 1989
Williams ST, Wolfering EA, O Dorisio TM, Fletcher WS: Effect of octreotide acetate on pancreatic exocrine function. Am J Surg 157:459–462, 1982
Gullo L, Biliotti G, Pezzilli R, DiStefano M, Ancona D: Effect of octreotide (SMS 201-995) on meal stimulated pancreatic secretion in 3 patients with external pancreatic fistula. Am J Gastroenterol 86:892–894, 1991
Craig RM, Atkinson AJJ:d-Xylose testing: A review. Gastroenterology 95:223–231, 1988
Pott G, Wagner H, Zierden E, et al: Influence of somatostatin on carbohydrate absorption in human small intestine. Klin Wochenschr 57:131–133, 1979
Candrina R, Gussago A, Giustina G: Effect of a new long-acting somatostatin analogue (SMS 201-995) on glycemic and hormonal response to a mixed meal in acromegalic patients. J Endocrinol Invest 11:21–26, 1988
Daughaday WH: Octreotide is effective in acromegaly but often results in cholelithiasis. Ann Intern Med 112:159–160, 1990
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This work was supported by Sandoz Pharmaceuticals Corp., East Hanover, New Jersey.
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Ho, J.J., Boyajy, L.D., Greenstein, E. et al. Effect of chronic octreotide treatment on intestinal absorption in patients with acromegaly. Digest Dis Sci 38, 309–315 (1993). https://doi.org/10.1007/BF01307549
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DOI: https://doi.org/10.1007/BF01307549