REVERSIBLE PARKINSONISM AND ATAXIA ASSOCIATED WITH HIGH-DOSE OCTREOTIDE

Abstract

Octreotide (Sandostatin, Novartis Pharmaceuticals) is a synthetic octapeptide analog of somatostatin or somatotropin release-inhibiting factor, a regulator of anterior pituitary release. It acts by inhibiting growth hormone, glucagon, and insulin. Octreotide is mainly used for the treatment of gastro-entero-pancreatic neuroendocrine tumors and acromegaly and its neurologic toxicity has been restricted to sleep disturbances, seizures, dizziness, depression, and headache. We here report the first case of dose-dependent reversible parkinsonism and ataxia in a young woman with carcinoid syndrome treated with a high dose of octreotide. ### Case report. This previously healthy 36-year-old woman developed impaired bilateral hand dexterity and overall slowness for about 1 year prior to her neurologic evaluation and 4 years after the initiation of treatment with octreotide and tyramine-restricted diet for carcinoid syndrome, diagnosed during her first pregnancy, at the age of 31 years. Then, she suffered paroxysmal swelling and redness in the upper body, hypoglycemia, and labile blood pressure, which forced an early vaginal delivery. She had been on escalating doses of octreotide, starting at 20 mg IM every 4 weeks and gradually increasing to 40 mg every 3 weeks. Two years prior to her presentation, physical exertion-induced recurrences prompted an additional dose …