Effects of octreotide on serum insulin-like growth factor I and insulin-like growth factor binding proteins in patients with cirrhosis

Abstract

Hyperinsulinaemia and reduced insulin sensitivity are common features in patients with cirrhosis. Octreotide, a long-acting somatostatin analogue, is used in cirrhotic patients in the treatment of bleeding oesophageal varices. Octreotide has potent effects on the growth hormone (GH )/insulin-like growth factor I (IGF-I ) axis in healthy subjects, but the effects on the GH/IGF-I axis in patients with cirrhosis have been described only briefly. The effects of a 12 h infusion of octreotide (bolus 0.75 &#119 g/kg followed by 0.75 &#119 g/kg/h) in 25 subjects (normals n = 9, compensated cirrhotics n = 8, decompensated cirrhotics n = 8) were compared with those in placebo-treated controls (n = 19) during fasting conditions. IGF-I, free IGF-I, IGF binding proteins (IGFBPs), insulin, C-peptide, GH and glucose were measured. Insulin resistance was calculated using the HOMA method. Octreotide reduced levels of total IGF-I in patients with compensated cirrhosis (p = 0.03) and free IGF-I in decompensated cirrhosis (p < 0.01). Insulin resistance was significantly reduced in normal subjects, whereas the reduction in insulin resistance did not reach statistical significance in patients with cirrhosis. In normal subjects, octreotide increased the IGFBP-1 area under curve threefold (p < 0.01) and decreased IGFBP-3 levels (p < 0.01), but these effects were blunted in the cirrhotic patients. Similarly, the reduction of insulin and C-peptide was blunted in the cirrhotic patients, whereas a significant reduction in GH was demonstrated in all groups. The effects of octreotide on the GH/IGF-I axis are mitigated in patients with cirrhosis and this may be a reflection of relative hyperinsulinaemia during octreotide treatment in these patients.

• C-PEPTIDE
• Free Igf-I
• Growth Hormone
• Igf-I Axis
• Insulin
• Igfbp-1
• Igfbp-3