Endocrine Abstracts

Background & Methods: Occasional case reports of individual patients with scalp hairloss while receiving somatostatin analogues for acromegaly led us to audit similar patients in our departments.

Results: Ten patients (four men, mean age at diagnosis 44.7years [range 26-65years]) who have received somatostatin analogues either initially as primary therapy (50%) or as post-surgical treatment (50%) for uncured acromegaly reported significant scalp hair loss, predominantly frontal & temporal, with onset of symptoms ranging between one and 24 months after commencing treatment (mean 5.4 months). Three patients were taking daily octreotide, five octreotide LAR and two lanreotide SR. Resolution of the alopecia is only documented in four of the patients, however, in only one of these patients was treatment with a somatostatin analogue stopped. Other possible causes of hairloss such as hypothyroidism, hypogonadism or side-effects of other medications were excluded. Other well documented side-effects of treatment occurred in our patient series; gastrointestinal symptoms in seven and the development of gallstones in four patients respectively.

Discussion & Conclusion: Alopecia is a side-effect of both standard and long-acting somatostatin analogues and importantly resolution may occur in some cases without necessitating drug discontinuation. The mechanism of hairloss is unclear but it does not appear to be simply related to a fall in growth hormone levels as when this is achieved by other means (eg. surgery) alopecia has not been noted. Equally, our results would appear to exclude hypogonadism as an underlying cause. A direct effect of these drugs on somatostatin receptors in the hair follicles seems plausible. The reason for hairloss limited to the scalp is unclear and may possibly reflect reporting bias on behalf of the patients as they may be more sensitive to hairloss in this area.