Severe and Prolonged Hypoglycemia Triggered by Long-Acting Octreotide in a Patient with Malignant Mesenchymal Tumor: Case Report

Abstract

Somatostatin analogues are potent growth hormone and glucagon inhibitors and are commonly used in the treatment of several endocrine and non-endocrine disorders. We report severe and longstanding hypoglycemia triggered by long-acting octreotide (Sandostatin LAR) in a 62-year-old women with malignant mesenchymal tumor. Hypoglycemia developed after 6 hours of octreotide injection and she was admitted to the emergency unit with sweating, tremor, palpitation and confusion. On admission, her plasma glucose level was: 17 mg/dl (normal: 65-110), cortisol: 31 μg/dl (normal: 5 - 25), insulin: 4.32 μIU/ml (normal: 6 - 27), C-peptide: 2.64 ng/ml (normal: 0.9 - 4.0), growth hormone: 0.06 ng/ml (normal: 0.06 - 5.0), insulin-like growth factor-I: 8.5 ng/ml (normal: 101 - 303), insulin-like growth factor binding protein-3: 1715 ng/ml (normal: 2020 - 3990). Intravenous dextrose infusion was given for a month to sustain normoglycemia since hypoglycemia recurred following cessation of infusion. Therefore, prednisolone, 35 mg/day was added and the parenteral dextrose infusion rate was decreased gradually and finally stopped. Normoglycemia could be maintained with prednisolone 20 mg/day. In patients prone to tumor hypoglycemia, long-acting octreotide may trigger severe and prolonged hypoglycemia due to suppression of counter-regulatory hormones; clinical trial with short-acting octreotide may be warranted to predict and prevent this life-threating complication.