From the Guidelines
Somatostatin is a hormone that inhibits the release of numerous other hormones and regulates the endocrine system, and its synthetic versions, such as octreotide and lanreotide, are used to treat conditions like carcinoid tumors, variceal bleeding, and certain pancreatic and intestinal disorders.
Definition and Function of Somatostatin
Somatostatin is a brain-gut peptide that inhibits the release of many hormones and can impair some exocrine functions, as stated in the study by Davies, Ramage, Bax, et al 1. It is made in the hypothalamus, pancreas, and digestive tract, and works by binding to specific receptors on cells to slow or stop the release of hormones like growth hormone, insulin, glucagon, and digestive enzymes.
Medical Use of Somatostatin Analogues
Medically, synthetic versions of somatostatin, such as octreotide (typical dose 100-600 mcg/day, divided into 2-4 subcutaneous injections) and lanreotide (60-120 mg deep subcutaneous injection every 4 weeks), are used to treat conditions like acromegaly, carcinoid tumors, variceal bleeding, and certain pancreatic and intestinal disorders, as mentioned in the study by Davies, Ramage, Bax, et al 1. These medications work by mimicking natural somatostatin but have longer half-lives, making them more practical for clinical use.
Side Effects and Monitoring
Side effects may include digestive issues, gallstones, and glucose metabolism disturbances, as reported in the study by Davies, Ramage, Bax, et al 1. Monitoring of circulating and, where relevant, urinary hormone levels should be undertaken during periods of treatment, as recommended in the study by Davies, Ramage, Bax, et al 1. Patients should also have regular relevant imaging.
Recent Guidelines and Recommendations
According to the most recent study by 1, patients who have metastatic NETs and carcinoid syndrome should be treated using a somatostatin analogue (octreotide or lanreotide). The long-acting release (LAR) formulation of octreotide is commonly used for the chronic management of symptoms in patients with carcinoid syndrome. Standard doses of octreotide LAR are 20 to 30 mg intramuscularly every 4 weeks.
- Key points to consider:
- Somatostatin analogues are the only proven hormonal management of NETs, as stated in the study by 1.
- Long-acting formulations of somatostatin analogues have produced significant improvement in the quality of life of patients with NET and have comparable or better efficacy than short-acting octreotide, as reported in the study by 1.
- Patients should generally be started on lower doses with treatment up-titrated to achieve stabilization, as recommended in the study by 1.
From the Research
Definition and Function of Somatostatin
- Somatostatin is a hormone that regulates the production of other hormones in the body [(2,3,4,5,6)].
- It is used to treat various conditions, including gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and acromegaly [(2,3,4,5,6)].
Somatostatin Analogues
- Somatostatin analogues, such as octreotide and lanreotide, are synthetic versions of somatostatin that are used to treat GEP-NETs and acromegaly [(2,3,4,5,6)].
- These analogues work by binding to somatostatin receptors, which helps to reduce the production of excess hormones [(3,4,5)].
- Long-acting release formulations of somatostatin analogues, such as octreotide LAR, have been developed to provide more convenient and consistent treatment [(3,5,6)].
Clinical Uses of Somatostatin Analogues
- Somatostatin analogues are used to control symptoms of GEP-NETs, such as diarrhea and flushing [(2,3,6)].
- They are also used to treat acromegaly, a condition caused by excess growth hormone production [(4,5)].
- Somatostatin analogues have been shown to have antiproliferative effects, which can help to slow the growth of tumors [(3,5)].
Side Effects and Challenges
- Somatostatin analogues can cause side effects, such as injection-site pain, gastrointestinal disorders, and hyperglycemia 2.
- Exocrine pancreatic insufficiency (EPI) is a rare but serious side effect of long-acting somatostatin analogues 2.
- Despite the effectiveness of somatostatin analogues, there are still challenges to be addressed, such as the need for more consistent bioavailability and better control of symptoms 6.