Endocrine Abstracts

Background: Very little is written regarding injection site reactions to somatostatin analogues and although very rare we are unprepared in dealing with these reactions. Patients are then met with an uncertain clinical team leading to significant delay in treatment. This poster aims to highlight the potential risks of injection site reactions by sharing an extreme case study. It will also share our attempt to deal with injection site reactions, lesson learnt and recommendations for the future. According to the product information pain, swelling and skin reactions are commonly reported by patients receiving somatostatin analogues. (EMC 2018 and BNF 2018). ‘Small subcutaneous nodules overlying the gluteal muscles’ are often reported in Ct scans. However I could only find one other report of such a rare skin reaction that required surgical intervention.

Clinical case: Mrs. A is 74 year old lady with a neuroendocrine tumour of the terminal ilium and Liver metastases. A 4 weekly Somatostatin Analogue was started and given at home by a specially trained nurse. Mrs A complained that her injection sites were painful and said that she felt as if the drug was not dispersing. In total she received 4 injections. After the fouth injection she was reviewed in clinic. She had 3 area’s which were clearly breaking down. One area was ulcerated requiring a dressing that the lady had put in place herself. Practice nurses started to dress the wound 3 times a week Consultant oncologist referred Mrs. A to the a surgeon who in turn referred her to plastic surgeons. There were delays in referrals being received. She was finally seen by a plastic surgeon 8 months following the referral from the oncologist. She received surgery a few weeks after this leaving significant scars.

Conclusion: Injection sites in patients receiving subcutaneous long acting somatostatin should receive regular examination for signs of fat necrosis. Patients experiencing continuous pain or discomfort in injection sites should be considered for an alternative formulation of somatostatin. Prompt assessment and escalation to the surgical teams is required to reduce an impact to patient’s quality of life.