Uneventful octreotide LAR therapy throughout three pregnancies, with favorable delivery and anthropometric measures for each newborn: A case report

Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel. .
Journal of Medical Case Reports 08/2011; 5:386. DOI: 10.1186/1752-1947-5-386
Source: PubMed

ABSTRACT The safety of octreotide use, in its short-acting preparation, in pregnancy is still unclear. This report provides the first documentation of uneventful octreotide LAR use during three pregnancies in a woman with bronchial carcinoid-associated adrenocorticotropic hormone-dependent Cushing's syndrome.
A 25-year-old Arabic woman presented to our emergency department with rapid onset of headache, flaring acne and hirsutism, facial puffiness, weight gain and paroxysmal myopathy, and paranoiac thoughts of rape and sexual intimidation. After undergoing surgical removal of a mass by left lower lung lobectomy, her residual lung disease medical therapy failed. Chronic octreotide LAR injections were initiated as indicated by a positive octreoscan.Follow-up revealed a long-lasting positive response to octreotide. Avidity of octreotide to somatostatin receptor sub-type 2 was later confirmed by a positive somatostatin receptor sub-type 2 in the resected tumor specimen. Against our instructions, the patient had three spontaneous pregnancies leading to delivery of three full-term healthy children while her octreotide LAR therapy continued.
This case adds more data supporting the potential for the safe use of octreotide and the feasibility of octreotide LAR use during pregnancy, making compliance with the patient's preference not to withdraw octreotide therapy as soon as her pregnancy is confirmed a thoughtful option.

Download full-text


Available from: Zaina Adnan, Sep 28, 2015
19 Reads
  • Archives of Gynecology 11/2012; 287(6). DOI:10.1007/s00404-012-2644-4 · 1.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context: Germline AIP mutations usually cause young-onset acromegaly with low penetrance in a subset of familial isolated pituitary adenoma families. We describe our experience with a large family with R304* AIP-mutation and discuss some of the diagnostic dilemmas and management issues. Objective: Identify and screen mutation carriers in the family. Patients: 43 family members. Setting: University hospitals. Outcome: Genetic and endocrine screening of family members. Results: We identified 18 carriers of the R304* mutation, 3 family members with an AIP-variant A299V and 2 family members who harbored both changes. One of the 2 index cases presented with gigantism and pituitary apoplexy and the other with young-onset acromegaly, and both had surgery and radiotherapy. Following clinical screening of the family, two R304* carriers were diagnosed both of whom had acromegaly. They underwent transsphenoidal surgery after a short period of somatostatin-analogue treatment. One of the patients is in remission; the other achieved successful pregnancy despite suboptimal control of acromegaly. One of the A299V carrier family members was previously diagnosed with a microprolactinoma; we consider this case to be a phenocopy. Height of unaffected R304* carrier family members is not different compared to non-carrier relatives. Conclusions: Families with AIP mutations present particular problems such as the occurrence of large invasive tumors, poor response to medical treatment, difficulties with fertility and management of pregnancy and the finding of AIP sequence variants of unknown significance. As disease mostly develops at younger age and penetrance is low, the timing and duration of follow up of carriers without overt disease requires further study. The psychological and financial impact of prolonged clinical screening must be considered. Excellent relationships between the family, endocrinologists and geneticists are essential and ideally these families should be managed in centers with specialist expertise.
    The Journal of Clinical Endocrinology and Metabolism 01/2013; 99(4):jc20132868. DOI:10.1210/jc.2013-2868 · 6.21 Impact Factor