Octreotide and urinary glycosaminoglycan in Graves' disease

Somatostatin Analogs in Clinical Practice: a Review

Somatostatin analogs are an invaluable therapeutic option in the diagnosis and treatment of somatotropinomas, thyrotropinomas, and functioning and non-functioning gastroenteropancreatic neuroendocrine tumors. They should also be considered an effective and safe therapeutic alternative to corticotropinomas, gonadotropinomas, and prolactinomas resistant to dopamine agonists. Somatostatin analogs have also shown to be useful in the treatment of other endocrine diseases (congenital hyperinsulinism, Graves’ orbitopathy, diabetic retinopathy, diabetic macular edema), non-endocrine tumors (breast, colon, prostate, lung, and hepatocellular), and digestive diseases (chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula).

[Novel treatment opportunities in Graves' orbitopathy]

Graves' orbitopathy is the most common extrathyroidal manifestation of Graves' disease. Up to now, curative treatment modalities for the most severe sight-threatening cases have not been developed. Here the authors summarize the treatment protocol of Graves' orbitopathy and review novel therapeutic options. They review the literature on this topic and present their own clinical experience. The authors point out that anti-CD20 antibody could positively influence the clinical course of Graves' orbitopathy. Selenium is efficient in mild cases. Further prospective investigations are warranted.

Lanreotide treatment in a patient with interferon-associated Graves? ophthalmopathy

BACKGROUND

We report a case of Graves' ophthalmopathy (GO) developed after the administration of interferon-alpha for chronic hepatitis C.

METHODS

The GO was treated with lanreotide.

RESULTS

A 47-year-old female patient presented with euthyroid GO with spontaneous retrobulbar pain, eyelid edema, conjunctival injection and eyelid retraction of the right eye and conjunctival injection of the left eye 6 months after administration of interferon-alpha for chronic hepatitis C. Orbital computed tomography revealed no involvement of extraorbital muscles and no increase in retrobulbar adipose tissue. Only soft tissue was involved. These symptoms subsided after 12 weeks of lanreotide treatment, except right eyelid retraction, which, however, disappeared later during follow-up.

CONCLUSION

The use of interferon-alpha may be complicated by GO and lanreotide might be considered for GO if patients cannot accept steroid therapy.

Effect of octreotide on postoperative intraperitoneal adhesions in rats

BACKGROUND

Octreotide, a long-acting somatostatin analogue that can inhibit glycosaminoglycan synthesis by fibroblasts in skin, may be a potent inhibitor of postoperative intraperitoneal adhesions. An animal model was developed to evaluate the effect of octreotide.

METHODS

Twenty-four male Wistar rats were divided into four groups. Laparotomy with a 15-cm intestinal resection and reanastomosis was performed on each group of rats. The intestinal serosa was also scratched to induce adhesion formation. No medication was given to group-1 rats (C). Group-2 rats received peritoneal irrigation with 6 ml normal saline intraoperatively (NS). Group-3 rats received irrigation with 6 ml octreotide solution (5 micrograms/ml) intraperitoneally (Oc). Group-4 rats received irrigation with 6 ml octreotide solution intraoperatively and 10 micrograms/kg of octreotide injection intramuscularly twice a day for 14 days (Oc + IM). All rats were killed 2 weeks later. The number of fibrous bands at and away from the anastomotic site was recorded. The strength and extent of the fibrous bands were also measured.

RESULTS

The total scores of intraperitoneal adhesion bands were significantly reduced in group Oc and group Oc + IM rats when compared with group C (p < 0.05). When the fibrous bands at the anastomotic site and away from it were distinguished, the results were the same. As to the strength and extent of intestinal adhesions, the data showed no significant difference among all four groups.

CONCLUSIONS

These data supported the suggestion that octreotide can reduce the incidence of postoperative intraperitoneal adhesions in rats.

An update on diagnostic methods in the investigation of diseases of the thyroid

Iodine deficiency and iodine-deficiency disorders continue to be problems in several parts of Europe, requiring further improvements in the techniques employed in thyroid diagnosis, and particularly in the early diagnosis and risk assessment of autonomously functioning thyroid tissue. For the latter purpose, scintigraphy with technetium-99m pertechnetate under exogenous or endogenous thyroid-stimulating hormone (TSH) suppression provides the best results. Significant methodological improvements in laboratory tests have resulted from the application of new luminescent techniques and gene technology to thyroid function tests. Especially TSH measurement using second- or third-generation assays ensures diagnostic accuracy, so that the thyrotropin-releasing hormone (TRH) test is now almost always unnecessary. The differentiation of blocking and stimulating TSH receptor antibodies is relevant when discrepant results are obtained with respect to thyroid function. Determination of glycosaminoglycans in urine may become a helpful tool in the follow-up of endocrine ophthalmopathy. Some new imaging agents have recently been applied in the scintigraphy of thyroid diseases, such as octreotide, or in thyroid diagnosis, such as fluorodeoxyglucose. Both improve the detectability of metastases of thyroid cancer, especially if the radioiodine scan is negative.

Successful surgical treatment of severe pretibial myxoedema

We report a 46-year-old man with severe and long-standing pretibial myxoedema, who responded well to local surgical treatment. This improvement has been maintained over a 12-month period, perhaps because of concomitant treatment with octreotide.

Somatostatin receptor scintigraphy and octreotide treatment in patients with thyroid eye disease

OBJECTIVE

Octreotide, a potent long-acting synthetic somatostatin analogue, has been reported to have a beneficial effect in thyroid eye disease (TED), but the precise mechanism of action remains unexplained. 111In-DTPA-D-Phe1-octreotide (Octreoscan-111) has been used to localize a number of endocrine tumours and visualize somatostatin receptors in the retrobulbar tissue of patients with TED. Furthermore, this technique can predict the inhibitory effect of octreotide on hormone secretion by endocrine tumours, as there is a close relation between the clinically observed inhibition and visualization of the tumour using Octreoscan-111. The aims of the present study were to confirm the beneficial effect of octreotide in patients with TED, to investigate the presence of somatostatin receptors in the orbital area and also, if possible, to ascertain whether this technique could select those patients with TED who might benefit from treatment with octreotide.

DESIGN

A prospective study.

SETTING

An endocrine clinic of a national hospital.

PATIENTS

Twenty treated thyrotoxic patients with TED, 5 treated thyrotoxic patients without TED and 5 normal individuals were studied. In 12 patients with TED, 5 without TED and 5 normal individuals, Octreoscan-111 scintigraphy of the orbits was performed. The remaining 8 patients with ophthalmopathy served as controls. In patients with TED who were investigated with Octreoscan-111, 300 micrograms octreotide daily was given for 12 weeks.

RESULTS

Six patients in both eyes and one patient in one eye showed an improvement in ocular manifestations as assessed by clinical criteria and changes in the NOSPECS score, while the rest showed no improvement. The patients who showed an improvement had a high number of somatostatin receptors and positive orbital scans, while with one exception the patients who did not respond had a low number of receptors and negative orbital scans (P < 0.02). None of the 5 patients without TED nor the normal individuals had a positive orbital scan. Seven out of 8 control patients with TED showed no change in the disease during the trial, while 1 deteriorated.

CONCLUSIONS

We conclude that octreotide has a beneficial effect in thyroid eye disease and that Octreoscan-111 could predict those patients with thyroid eye disease who might benefit from this treatment.