Endocrine Abstracts

Analogues of somatostatin are widely used in management of neuroendocrine tumors. The “classic” indications for this treatment are: acromegaly and NETs of midgut to diminish symptoms caused by hormonal overproduction and slow down the tumors’ growth. However we consider the use of this medication also in the other cases in which we confirm the presence of somatostatin receptors in tumor by somatostatin receptor scintigraphy.

We would like to present three cases of symptomatic, resistant to pharmacological therapy, neuroendocrine tumors, in which only preoperative treatment with long-acting Octreotide enabled successful surgery.

Case 1. 40-years-old man with profound hypoposphataemia caused by GF-23 secreting tumor in the right maxillary sinus (glomangiopericytoma). The treatment with phosphorus and active vitamin D metabolites was ineffective. The improvement of phosphorus concentration was necessary for safety of anesthesia and proper function of respiratory muscles after the extubation, so waiting for surgery patient was treated with long acting Octreotide, and phosphorus level increased to proper values.

Case 2. 44-years-old woman with paroxysmal tachycardia and hypertension up to 200/140 caused by catecholamine secreting tumor localized in mediastinum (paragandglioma). The preoperative treatment with alpha, beta and calcium channel blockers and also ACI and diuretics was ineffective. On the second day after the Octreotide injection the blood pressure fell down and directly before surgery only the alpha and beta blockers were used.

Case 3. 50-years-old woman with paroxysmal sweating and hypertension up to 240/140 caused by pheochromocytoma of the left adrenal gland. The treatment as in the case above – also ineffective; she was twice disqualified from the operation due to blood pressure>200/120. After the Octreotide injection the blood pressure fell down, however the reduction of the medications before surgery was impossible.

These cases exemplify possibility of unconventional use of long acting somatostatin analogues in preoperative treatment of rare neuroendocrine tumors.