POSTPRANDIAL GALL-BLADDER MOTILITY AND HORMONE-RELEASE DURING INTERMITTENT AND CONTINUOUS SUBCUTANEOUS OCTREOTIDE TREATMENT IN ACROMEGALY

Repeated daily injections of the somatostatin analogue, octreotide (SM S201-995, Sandostatin) are an effective treatment for acromegaly, but lead to gall stone formation in about 50% of cases during longterm tre atment. This is probably because of impaired gall bladder contraction. This study examined whether the timing of intermittent injections in relation to meals, or alternatively, continuous 24 hour subcutaneous o ctreotide infusion (CSOI) might avert adverse effects or. gall bladder contraction. In six patients with active acromegaly, gall bladder vol ume, plasma cholecystokinin (CCK), and pancreatic polypeptide (PP) wer e measured in the fasting state and after consumption of a fatty meal. Measurements were made on five separate days: (a) without treatment, (b) 45 minutes after 100 mug octreotide given subcutaneously, (c) four hours after 100 mug octreotide given subcutaneously, (d) eight hours after 100 mug octreotide given subcutaneously, and (e) during CSOI of 300 mug/24 h for two weeks. Without treatment, postprandial gall bladd er contraction was 86.2 (2.1%). Fasting gall bladder volume increased after octreotide injection and was almost doubled during CSOI. Octreot ide injections impaired postprandial gall bladder contraction as well as CCK and PP release for at least four hours. Eight hours after injec tion and during CSOI, postprandial gall bladder contraction was partly restored (43.4% and 50.8% respectively). Postprandial CCK release was normal at eight hours after injection but very low during-CSOI. PP re lease was suppressed by each mode of octreotide treatment. This study indicates that octreotide injections impair postprandial gall bladder contraction for at least four hours. Eight hours after injection and d uring CSOI, gall bladder contraction is partly restored.