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Severe Hypertension Induced by the Long-Acting Somatostatin Analogue Sandostatin LAR in a Patient with Diabetic Autonomic Neuropathy

Department of Internal Medicine, Division of Endocrinology and Metabolism (R.P.-B., M.J.S.), and Division of Gastroenterology (W.C.), University of Michigan, Ann Arbor, Michigan 48109-0678

Address correspondence and requests for reprints to: Martin J. Stevens, Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Michigan Medical Center, 5570 MSRB II, Box 0678, 1150 West Medical Center Drive, Ann Arbor, Michigan 48109-0678. E-mail: stevensm{at}umich.edu

A 26-yr-old woman with type 1 diabetes and severe symptomatic autonomic neuropathy was treated with the long-acting somatostatin analogue Sandostatin LAR for intractable diarrhea. Her diarrhea had previously been successfully managed with three daily injections of octreotide without adverse consequences. She was given a single dose of Sandostatin LAR and within 2 weeks reported the development of increasingly frequent and severe headaches. Three weeks after the injection, she was admitted to hospital with severe hypertension, which eventually resolved with the administration of antihypertensive agents. No other underlying cause of the hypertension was discovered. Rechallenge of the patient with octreotide resulted in a transient hypertensive episode, which lasted 3 h. Severe hypertension, therefore, seems to be a possible adverse effect of treatment of diabetic diarrhea with somatostatin analogues, which should be used with great caution in subjects with severe autonomic dysfunction.