Cardiovascular effects of depot long-acting somatostatin analog Sandostatin LAR in acromegaly

• Published in: The journal of clinical endocrinology and metabolism 2000-09, Vol.85 (9), p.3132-3140
• Main Authors: COLAO, Annamaria, MARZULLO, Paolo, FERONE, Diego, SPINELLI, Letizia, CUOCOLO, Alberto, BONADUCE, Domenico, SALVATORE, Marco, BOERLIN, Viktor, LANCRANJAN, Ioana, LOMBARDI, Gaetano
• Format: Article
• Language: English
• Subjects: Acromegaly - diagnostic imaging; Acromegaly - drug therapy; Acromegaly - physiopathology; Adult; Aged; Biological and medical sciences; Delayed-Action Preparations; Echocardiography; Electrocardiography; Exercise - physiology; Female; Gated Blood-Pool Imaging; Hemodynamics - drug effects; Hormones. Endocrine system; Human Growth Hormone - blood; Humans; Insulin-Like Growth Factor I - metabolism; Male; Medical sciences; Middle Aged; Octreotide - therapeutic use; Pharmacology. Drug treatments; Ventricular Function, Left - drug effects; Ventricular Function, Left - physiology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.85.9.3132

Cardiovascular disease is the most severe complication of acromegaly accounting for the increased mortality of these patients. Recently, the slow-release form of octreotide (OCT; Sandostatin LAR, OCT-LAR), for im injection every 28 days, was reported to induce suppression of GH levels below 7.5 mU/L (2.5 microg/L) in 39-75% of patients, and normalization of insulin-like growth factor (IGF)-I levels for age in 64-88% of patients, with an excellent patients' compliance. The aim of the present study was to investigate the early effect of OCT-LAR treatment on the left ventricular (LV) structure and performance in 15 somatostatin analog-naive patients with acromegaly (GH, 94.8 +/- 24.9 mU/L; IGF-I, 757.9 +/- 66.6 microg/L), focusing on the early effect of GH and IGF-I suppression on the heart. Cardiac structure was investigated by echocardiography, whereas LV performance was investigated by gated-blood-pool scintigraphy, before and after 3 and 6 months of treatment with OCT-LAR. OCT-LAR was initially administered im, at a dose of 20 mg every 28 days, for 3 months. In six patients, the dose was then increased to 30 mg every 28 days to achieve disease control, which was considered when fasting and/or glucose-suppressed GH values were below 7.5 and 3.0 mU/L, respectively, together with IGF-I values within the normal range for age. The treatment with OCT-LAR for 6 months induced a significant decrease of GH (to 12.9 +/- 3.0 mU/L) and IGF-I levels (to 340.3 +/- 40.2 microg/L) in all 15 patients. After 6 months of treatment, the percent IGF-I suppression was 52.8 +/- 4.4%, and serum GH/IGF-I levels were normalized in 9 patients. A significant decrease of LV mass index (LVMi), interventricular septum thickness, and LV posterior wall thickness was observed in all 15 patients after 3 and 6 months of OCT-LAR treatment: LVMi was decreased by 19.1 +/- 2.0% without any difference in patients with (19.9 +/- 2.7%) or without disease control (17.8 +/- 3.3%). Among the 11 patients with LV hypertrophy, 6 normalized their LVMi after treatment. At study entry, an inadequate LV ejection fraction (LVEF) at rest (