What is the mechanism of action of somatostatin?
Octreotide is a synthetic analog of
somatostatin, which is a natural growth inhibitor that also competitively
inhibits release of several hormones. It decreases serotonin levels and
relieves the symptoms of carcinoid syndrome. Somatostatin has been shown to
suppress diarrhea associated with VIP tumors. It has a transient half-life;
therefore, intravenous infusions are required for treatment of acute crises.
For preoperative prophylaxis, octreotide 50–150 μg every 8 hours subcutaneously is recommended.
If patients are on long-term therapy, the dose can be adjusted accordingly.
Side-effects include ascending cholangitis or cholelithiasis because
somatostatin inhibits gallbladder contractions. Other side-effects include
nausea, vomiting, pain, diarrhea, and bradycardia. This occurs more commonly
with larger doses. Symptoms are variable in different patients. Steatorrhea is
occasionally observed, but this is generally mild and not associated with
significant nutritional impairment. Somatostatin suppresses the response of
leutinizing hormone (LH) to gonadotropic releasing hor-mone (GnRH). It
decreases splanchnic blood flow and inhibits the release of serotonin, gastrin,
VIP, and pancre-atic polypeptide. VIP-omas tend to cause watery diarrhea rather
than steatorrhea, which is common with metastatic carcinoid tumors. Octreotide
reduces growth hormone levels in patients with acromegaly as well.
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