From the Guidelines
Octreotide is not recommended for the treatment of hypoglycemia in patients with insulinoma, as it can worsen hypoglycemia by suppressing counterregulatory hormones such as glucagon. The use of octreotide in patients with insulinoma is generally not advised, except in cases where the tumor is somatostatin scintography-positive, and even then, it should be used with caution and close monitoring of blood glucose levels 1.
Key Considerations
- Octreotide can suppress counterregulatory hormones, leading to worsening hypoglycemia in patients with insulinoma.
- The treatment of choice for hypoglycemia in patients with insulinoma is typically diet and/or diazoxide, with everolimus considered in some cases 1.
- Somatostatin scintography should be performed before considering octreotide or lanreotide treatment, and these medications should only be administered to patients with positive results 1.
Clinical Implications
- Patients with insulinoma should be carefully monitored when receiving somatostatin analogues, as these medications can profoundly worsen hypoglycemia in some cases 1.
- Blood glucose levels should be closely monitored in patients with insulinoma, and treatment should be adjusted accordingly to prevent hypoglycemia.
- The use of octreotide in patients with insulinoma should be approached with caution, and alternative treatments should be considered whenever possible 1.
From the FDA Drug Label
Octreotide acetate injection alters the balance between the counter-regulatory hormones, insulin, glucagon and growth hormone (GH), which may result in hypoglycemia or hyperglycemia. Symptomatic hypoglycemia, which may be severe, has been reported in patients with concomitant Type I diabetes mellitus. In nondiabetics and Type II diabetics with partially intact insulin reserves, octreotide acetate injection administration may result in decreases in plasma insulin levels and hyperglycemia.
The indication for Octreotide (Somatostatin analogue) in the treatment of hypoglycemia is not supported by the FDA drug label. The label actually warns about the risk of hypoglycemia as a potential side effect of octreotide acetate injection therapy, rather than indicating it as a treatment for hypoglycemia 2.
From the Research
Indication for Octreotide in Hypoglycemia Treatment
The use of Octreotide, a somatostatin analogue, has been studied in the treatment of hypoglycemia, particularly in patients with insulinoma.
- Octreotide has been shown to be effective in treating hypoglycemia in patients with insulinoma, with studies demonstrating its ability to elevate plasma glucose levels and decrease serum immunoreactive insulin (IRI) levels 3, 4.
- The efficacy of octreotide in treating hypoglycemia is associated with the presence of somatostatin receptors, particularly sst2A, on the tumor 4.
- However, octreotide may also exacerbate hypoglycemia in some patients, particularly if it suppresses glucagon secretion 5, 6.
- In cases where surgery is not possible, octreotide can be used as a medical treatment for hypoglycemia, with long-acting formulations providing effective long-term management 3, 7.
Patient Selection and Treatment Monitoring
- Patient selection for octreotide treatment should be based on a positive response to a short test with subcutaneous octreotide, rather than relying solely on Octreoscan scintigraphy results 4.
- Monitoring of blood glucose and glucoregulatory hormone levels is essential during octreotide treatment to minimize the risk of hypoglycemia 5.
- The use of a preliminary loading test with short-acting octreotide may be useful in determining the appropriateness of treatment, especially in cases where surgical treatment is not possible 7.