Subcutaneous Injection Of Octreotide Research Articles

Primary weight loss failure after Roux-en-Y gastric bypass is characterized by impaired gut-hormone mediated regulation of food intake

Background/ObjectivesAfter Roux-en-Y gastric bypass (RYGB) a subset of patients never obtain excess BMI loss (EBMIL) > 50% and are categorized as having primary weight loss (WL) failure. We hypothesized that postprandial concentrations of glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) would be lower in patients with primary WL failure compared with patients with successfully maintained WL. Furthermore, that inhibition of gut hormone secretions would increase ad libitum food intake less in patients with primary WL failure.Subjects/MethodsTwenty women with primary WL failure (LowEBMIL < 50%) were individually matched to twenty women with successful WL (HighEBMIL > 60%) on age, preoperative BMI and time from RYGB. On separate days performed in a random order, patient-blinded subcutaneous injections of octreotide or saline (placebo) were followed by a fixed breakfast and an ad libitum lunch with blood sampling for appetite regulating hormones and Visual-Analogue-Scale (VAS)-scoring of hunger/satiety. Furthermore, participants underwent gene variant analysis for GLP-1, PYY and their receptors, indirect calorimetry, dual-energy X-ray absorptiometry (DXA)-scans, 4-days at-home food registration and 14-days step counting.ResultsOn placebo days, postprandial GLP-1, PYY and cholecystokinin (CCK) concentrations were similar between groups after breakfast. Fasting ghrelin was lower in LowEBMIL, but the postprandial suppression was similar. LowEBMIL had lower satiety VAS-scores and less suppression of hunger VAS-scores. Gene variants did not differ between groups. Octreotide diminished GLP-1, PYY, CCK and ghrelin concentrations in both groups. Octreotide did not affect ad libitum food intake in LowEBMIL (−1% [−13, 12], mean [95%CI]), while food intake increased in HighEBMIL (+23% [2,44]).ConclusionsPrimary WL failure after RYGB was not characterized by impaired secretions of appetite regulating gut hormones. Interestingly, inhibition of gut hormone secretions with octreotide only increased food intake in patients with successful WL post-RYGB. Thus, an impaired central anorectic response to gut hormones may contribute to primary WL failure after RYGB.

Octreotide may improve pharyngocutaneous fistula healing through downregulation of cystatins: A pilot study.

Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hypothesized that octreotide induces alterations in the saliva proteome and that these alterations may provide insight into the mechanism of action underlying improved PCF healing. We undertook an exploratory pilot study in healthy controls that involved collecting saliva before and after a subcutaneous injection of octreotide and performing proteomic analysis to determine the effects of octreotide. Four healthy adult participants provided saliva samples before and after subcutaneous injection of octreotide. A mass-spectrometry based workflow optimized for the quantitative proteomic analysis of biofluids was then employed to analyze changes in salivary protein abundance after octreotide administration. There were 3076 human, 332 Streptococcus mitis, 102 G. haemolyans, and 42 Granulicatella adiacens protein groups quantified in saliva samples. A paired statistical analysis was performed using the generalized linear model (glm) function in edgeR. There were and ~300 proteins that had a p< .05 between the pre- and post-octreotide groups ~50 proteins with an FDR-corrected p< .05 between pre- and post-groups. These results were visualized using a volcano plot after filtering on proteins quantified by 2 more or unique precursors. Both human and bacterial proteins were among the proteins altered by octreotide treatment. Notably, four isoforms of the human cystatins, belonging to a family of cysteine proteases, that had significantly lower abundance after treatment. This pilot study demonstrated octreotide-induced downregulation of cystatins. By downregulation of cystatins in the saliva, there is decreased inhibition of cysteine proteases such as Cathepsin S. This results in increased cysteine protease activity that has been linked to enhanced angiogenic response, cell proliferation and migration that have resulted in improved wound healing. These insights provide first steps at furthering our understanding of octreotide's effects on saliva and reports of improved PCF healing.

ROLE OF OCTREOTIDE IN MANAGEMENT OF SULPHONYLUREA - INDUCED REFRACTORY HYPOGLYCEMIA : A CASE REPORT

Hypoglycemia in diabetes is generally the result of interplay of relative or absolute therapeutic exogenous or endogenous insulin excess and compromised physiological and behavioral defenses against falling blood glucose concentrations. Thus, it is fundamentally iatrogenic, the result of treatments that include insulin or an insulin secretagogue such as glimepiride. The long-acting, synthetic somatostatin analog, octreotide, can be used to correct refractory hypoglycemia caused by sulfonylurea. There have been few records of it being used in a clinical environment. We present a case in which a subcutaneous injection of octreotide was successful in treating sulfonylurea-induced refractory hypoglycemia. The patient was referred to our hospital for recurrent hypoglycemia caused by sulfonylurea. His medications included tablet glimepiride 4 mg once daily along with tablet metformin 1000mg once daily. His plasma glucose level on arrival was 45 mg/dl. He was treated with 50 ml of 25% glucose solution and administered continuous drip of 5% glucose solution through a peripheral vein, but his hypoglycemia recurred several times. Finally, 100 mcg of octreotide was subcutaneously injected. Thereafter, hypoglycemia did not recur, and additional injections of glucose were not required. The subcutaneous injection of octreotide can be an effective and safe method of treating prolonged, and refractory hypoglycemia caused by sulfonylureas and alleviate impending complications, morbidity, and/ or mortality. The octreotide subcutaneous injection can be used as outpatient department treatment and can greatly reduce the cost of hospitalization.

Uniportal video-assisted thoracoscopic surgery right thoracic duct ligation for chyle leak following right supraclavicular lymph node biopsy: a case report

: Chyle leak is a rare but known complication following head and neck surgery, especially after resection of tumour in the base of the neck. The diagnosis of chyle leak can be made by demonstrating milky drainage, fluid analysis for chyle (triglyceride level >110 mg/dL, lymphocyte count >90% of total white blood cell count or total protein content similar to plasma) as well as lymphangiogram to identify the leak point. Low output chyle leak (<500 mL/day) is usually managed successfully by non-surgical approach which consist of dietary modification (fat intake <10 g/day), pharmacological treatment (subcutaneous octreotide injection 0.1 mg every 8 hours for 3 to 5 days) and drainage. However, if conservative measures fail or in high output chyle leak, surgical intervention is indicated. Thoracic duct ligation by uniportal video-assisted thoracoscopic surgery (VATS) is rarely described in the literature. In this case report, we describe a patient with chyle leak after right supraclavicular lymph node biopsy whom failed non-surgical management and underwent right uniportal VATS thoracic duct ligation, without dividing the duct. The patient made uneventful recovery with complete resolution of chyle leak. Uniportal VATS ligation of thoracic duct for chyle leak can be considered as the primary approach for surgical treatment.

Rare case of recurrent chylothorax following irradiation for esophageal cancer

Introduction: Chylothorax is a rare cause of pleural effusion that results from damage of the thoracic duct and chyle leakage from the lymphatic system into the pleural space. Causes of chylothorax can be traumatic or non-traumatic. Chylothorax occurring due to damage to the thoracic duct by thoracic irradiation is rare, and infrequently described in the literature. Case Report: We present a case of a 74-year-old patient with a history of stage IV esophageal cancer who developed recurrent bilateral chylothoraces after palliative radiotherapy to her esophagus. She was treated conservatively with multiple modalities, including total parental nutrition leading to an oral low-fat medium-chain triglyceride diet, subcutaneous octreotide injection, and long-term insertions of bilateral chest drains. Conclusion: This case report and discussion highlight that chylothorax is a rare complication of radiotherapy. A suspicion of chylothorax should be raised in patients who present with recurrent pleural effusions after radiotherapy to the esophagus or mediastinum, as early intervention can improve outcomes in these patients.

Efficacy and safety of octreotide treatment for diazoxide-unresponsive congenital hyperinsulinism in China.

ABSTRACTImportanceOctreotide is an off‐label medicine for congenital hyperinsulinism (CHI), but is currently widely used for treatment of patients with CHI. Thus far, variable efficacy and adverse effects have been reported for octreotide.ObjectiveThe present study evaluated the efficacy and safety of a subcutaneous octreotide injection for treatment of diazoxide‐unresponsive CHI in China.MethodsThis study was a retrospective review of children with diazoxide‐unresponsive CHI who were treated with a subcutaneous octreotide injection. The efficacy and side effects of the treatment were assessed.ResultsTwenty‐five Chinese children (15 boys) were involved in the study. Their median age at diagnosis was 8 weeks (range, 1–24 weeks) and median age at the final follow‐up was 1.8 years (range, 0.3–3.3 years). Octreotide therapy effectively increased blood glucose levels in all patients. The intravenous glucose infusion rate was reduced in all patients. Twenty‐one patients gradually discontinued the intravenous glucose infusion while receiving octreotide combined with frequent carbohydrate/glucose‐rich feeding. Among patients with a monoallelic ATP‐sensitive potassium (KATP) channel mutation, 50.0% showed gradual remission during follow up, indicating that the octreotide treatment may be a feasible alternative to surgery, especially for patients with monoallelic KATP‐channel mutations. Transient elevation of liver enzymes occurred in 20.0% of patients, while asymptomatic gallbladder pathology occurred in one patient. The growth rates of these patients were normal (height standard deviation score was 0.3 ± 1.5 at the final follow‐up).InterpretationOctreotide was a well‐tolerated, effective therapy for most children with diazoxide‐unresponsive CHI.

PREVENTION OF ACUTE PANCREATITIS DURING ENDOSCOPIC TRANSPAPILLARY INTERVENTIONS

Aim. To identify the major risk factors of acute postoperative pancreatitis, to determine optimal volume of drug prevention, to study the possibility of intravenous administration of octreotide 600 mcg/ml in transpapillary endoscopic interventions. Material and Methods. In group I (72 patients) prevention of acute post-manipulation pancreatitis prior to endoscopic transpapillary interventions included intravenous administration of octreotide 600 mcg diluted in 60 ml 0.9% sodium chloride solution (NaCl). On the day of endoscopic intervention octreotide was administered fractionally 200 mcg 3 times per day. In group II (78 patients) acute pancreatitis was prevented by subcutaneous injection of octreotide 100 mcg before endoscopic intervention and subsequent 3-fold subcutaneous injection of 100 mcg on the day of surgery. Results. Risk factors of acute pancreatitis are young age, difficult cannulation of major duodenal papilla, atypical papillosphincterotomy, contrast injection into pancreatic duct. It is proved that intravenous administration of octreotide 600 mcg/ml reduces the risk of acute pancreatitis and transient hyperamylasemia from 16.7% and 19.2% to 11.1% and 16.7% respectively compared with conventional subcutaneous injection (100 mcg). Thus, it reduces the duration ( p &lt; 0.016) and severity of hyperamylasemia (p &lt; 0.005). Conclusion. Intravenous administration of octreotide 600 mcg/day is more effective and convenient compared with conventional scheme to prevent acute postmanipulation pancreatitis.

Giant Fundic Gland Polyps in a Rare Disease

Our patient is a 39-yr-old previously healthy Hispanic female who complains of years of epigastric pain, acutely worsening over the past 2 weeks. She complained of 80lb weight loss, fatigue & intermittent diarrhea over the past 1.5 years. Otherwise review of systems was negative. Medications included omeprazole & ibuprofen prn. Family & social history were unrevealing. On physical examination, vitals were normal with palpable thyroid, mild tenderness over epigastrium with palpation. Lab tests revealed: Hemoglobin 2.1g/dL;hemocrit 8.7%. Multi-chemistry screen was remarkable for Ca 11mg/dL. EGD revealed multiple giant gastric polyps (15-40mm), thickened gastric folds without discrete mass or ulcerations (Figure 1&2). Histology of gastric polyp biopsies showed cystically dilated fundic glands lined by normal gastric epithelium, without evidence of dysplasia, consistent with fundic gland polyps. Colonoscopy was notable for a single diminutive tubular adenoma. Contrasted CT abdomen/pelvis was notable for a mass in the tail of pancreas measuring 1.6cm & portocaval mass measuring 7.8cm. Fasting serum gastrin level was >10000. EUS with FNA of pancreatic & portocaval mass/lymph node was performed with malignant cells of a well differentiated neuroendocrine tumor, low grade. Due to hyperparathyroidism, the patient underwent parathyroidectomy & partial thymectomy that revealed parathyroid adenoma. Our patient met criteria for multiple endocrine neoplasia type 1a with parathyroid tumor, metastatic pancreatic neuroendocrine neoplasm & Zollinger-Ellison syndrome. She was started on high-dose proton pump inhibitor & subcutaneous octreotide injections. Surgical oncology & tumor board consultation yielded decision to continue depot octreotide lifelong given metastatic disease. She underwent evaluation for pituitary tumors including prolactin & MRI of sella turcica, which were negative. Her epigastric pain & anemia improved on PPI and octreotide & will continue surveillance for pituitary tumors & GI tumor progression. Genetic testing revealed a pathogenic mutation in the MEN1 gene (c.1406_1413dupAGCCGTGG), confirming diagnosis of an index case of sporadic MEN1a. Detection of sporadic MEN1a requires a high degree of suspicion & should be considered in cases of epigastric pain, diarrhea with concomitant hyperparathyroidism. Previous association of giant fundic gland polyps & MEN1 has not been reported.Figure: Stomach.Figure: Giant fundic gland polyp.

Delayed pancreatic fistula-rare complication of left nephrectomy

Pancreatic fistula is an important and possible complication of left nephrectomy performed for inflammatory or malignant lesions of kidney. This may develop due to intimate relationship of tail of pancreas to left kidney. The objective is to report this unusual case of delayed pancreatic cutaneous fistula which patient developed eight years after left nephrectomy. The patient was managed conservatively with subcutaneous injections of octreotide which led to closure of fistula and healing of excoriation.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.483-484

Intestin des connectivites et vascularites

Intestinal involvement is frequent in connective tissue disorders and vasculitides. Among the connective tissue diseases, intestinal involvement is particularly prevalent in systemic sclerosis (SSc). SSc is characterized by intestinal pseudo-obstruction, which may be complicated by small intestinal bacterial overgrowth (SIBO) syndrome and malabsorption. These intestinal syndromes are potentially severe, as they can lead to severe malnutrition and cachexia. Treatment is often difficult; it might require subcutaneous octreotide injections and must associate the treatment of SIBO, based on cycled antibiotics. Intestinal involvement is often regarded as a severe complication of vasculitides. Some clinical manifestations are common to all vasculitides, including ischemia, bowel infarction and perforations, as well as hemorrhage due to mucosal ulcerations or aneurismal ruptures. Some manifestations are more specific and are detailed in this review. Clinical manifestations are often nonspecific and digestive explorations usually have no prognostic value. Treatment of these patients is based on potent immunosuppressive agents, and sometimes requires prompt surgery in case of surgical abdomen.

A Case of Dermatomyositis and Anti-EJ Autoantibody with Chronic Intestinal Pseudoobstruction Successfully Treated with Octreotide.

Chronic intestinal pseudoobstruction (CIPO) is a serious complication in patients with connective tissue disease (CTD) and is sometimes life-threatening or fatal despite intensive medical treatment. Here, we report a patient with dermatomyositis (DM) and anti-EJ autoantibody who developed CIPO that was improved by octreotide. Because her abdominal pain and bloatedness were so severe and persistent, we introduced octreotide to relieve symptoms. In this case, continuous intravenous administration as well as long-acting subcutaneous injection of octreotide was effective for treating CIPO.

Glucagonoma with necrolytic migratory erythema exhibiting responsiveness to subcutaneous octreotide injections

A 51-year-old woman with a half-year history of diabetes mellitus presented to our gastrointestinal clinic with an ulcerating rash, primarily on her shins, thighs, groin and abdomen (Figure 1a); cheilitis and glossitis. Her symptoms had been worsening for 10 months despite specialized wound care. In addition, she noted concurrent weight loss from 57 to 47 kg in 10 months, abdominal pain, abdominal fullness and poor …

Octreotide improves early dumping syndrome potentially through incretins: a case report

Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75 g oral glucose tolerance test (75 g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75 g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.

The temporary drop of serum octreotide concentration deteriorated ventricular tachycardia in an acromegalic patient

Acromegaly is frequently accompanied by left ventricular hypertrophy (LVH) which causes ventricular dysfunction. Ventricular arrhythmia is one of the important complications in acromegalic patients. Hypertrophic cardiomyopathy (HCM) is characterized by LVH with a nondilated chamber. About 10 % of HCM evolve into dilated phase of HCM, which is associated with an increased incidence of ventricular tachycardia (VT). However there is no report about a combination of dilated phase of HCM and VT in acromegalic patients. Octreotide is a somatostatin analog that has been used for medical therapy for acromegaly. We herein report that the first case of the change of serum octreotide concentration affected the control of VT, which was induced by dilated phase of HCM. A 56-year-old Japanese man was referred to our hospital for treatment of acromegaly. The patient was diagnosed the dilated phase of HCM with sustained VT. The frequency and severity of VT were gradually ameliorated by subcutaneous octreotide injection. However VT was deteriorated when its injection was changed to octreotide long-acting release (LAR) injection. The temporary drop in serum octreotide concentration was known at the transition from subcutaneous injection to LAR injection. This clinical course gives us the important information that subcutaneous octreotide injection for two weeks should be necessary to keep serum octreotide concentration when switing to octreotide LAR administration in acromegalic patients with severe arrhythmia.

Octreotide inhibits capsaicin-induced activation of C and Aδ afferent fibres in rat hairy skin in vivo

1. The present study investigated whether the somatostatin receptor (SSTR) agonist, octreotide, could inhibit the activation of dorsal skin afferent fibres induced by local injection of capsaicin in the rat. 2. Single unit activity from Aδ mechano-heat sensitive (AMH; n = 41) and C mechano-heat sensitive (CMH; n = 30) afferents was recorded after their isolation in thin filaments from the dorsal cutaneous nerve branches. The effect of subcutaneous octreotide injection on the change in discharge rate and mechanical threshold induced by capsaicin was determined. 3. Capsaicin (0.05%) injection into the edge of the receptive field of both AMH and CMH units increased their discharge rate and decreased their mechanical threshold. Pre-injection of octreotide inhibited these responses, and co-application of SSTR antagonist, cyclosomatostatin, reversed the inhibitory effect of octreotide. 4. The present study provides electrophysiological evidence that the signal evoked by the somatostatin receptor inhibits the activation and mechanical sensitization evoked by capsaicin in the terminals in small-diameter sensory neurons.

Successful treatment of canine necrolytic migratory erythema (superficial necrolytic dermatitis) due to metastatic glucagonoma with octreotide

Necrolytic migratory erythema (NME; also known as superficial necrolytic dermatitis) is a syndrome most often associated with certain chronic liver diseases or pancreatic glucagonomas. In humans with glucagonoma-associated NME, skin lesions usually respond to octreotide, a somatostatin analogue that inhibits glucagon release. In this report an 11-year-old golden retriever dog with pancreatic glucagonoma and metastasis to the regional lymph nodes, spleen and liver was diagnosed with NME. The dog exhibited erosions, ulcers and crusts on the paws, pressure points, muzzle, periocular area and prepuce. The dog was also anorexic and had difficulty walking. Because metastasis precluded surgery, treatment was initiated with subcutaneous octreotide (2 μg/kg twice daily). Skin lesions and systemic clinical signs improved markedly within 5 days. The dosage was increased to nearly 3 μg/kg twice daily and signs almost completely resolved within 10 days. Anorexia was the major adverse effect observed. During the following month, both dosage (1-3.7 μg/kg) and frequency (two to four times daily) of the octreotide injections were adjusted to permit control of clinical signs while maintaining adequate appetite. Temporary cessation of octreotide administration resulted in the rapid recurrence of skin lesions. Resuming injections led to improvement of clinical signs within 48 h. The dog was later euthanized because of progressive metastatic disease. In conclusion, subcutaneous octreotide injections were beneficial in this dog with glucagonoma-associated NME. This somatostatin analogue could be a valuable option to treat canine patients with non-resectable or relapsing pancreatic glucagonoma-associated NME.

Influência do octreotide subcutâneo na cicatrização de sutura gástrica em ratos

RACIONAL: Octreotide, análogo sintético da somatostatina, é potente inibidor da secreção gástrica, intestinal e pancreática. Reduz fluxo sangüíneo esplâncnico, acelera esvaziamento gástrico e prolonga tempo de trânsito intestinal, estimulando a absorção de água e eletrólitos. Freqüentemente é utilizado no tratamento das fístulas digestivas pela sua capacidade de reduzir o débito da fístula, porém a redução do fluxo sangüíneo poderia interferir negativamente na cicatrização. OBJETIVO: Avaliar a influência do octreotide na cicatrização de sutura gástrica em ratos. MÉTODOS: Foram utilizados 39 ratos Wistar machos, divididos em dois grupos, controle e octreotide, subdivididos em 4 e 7 dias, de acordo com o dia da morte do animal. Todos foram submetidos à gastrotomia e fechamento com pontos seromusculares interrompidos. Os animais do grupo octreotide receberam dose única diária do medicamento por via subcutânea. O grupo controle recebeu solução salina a 0,9%. Foram determinados o percentual de colágeno maduro e imaturo, pela técnica de picrosirius-red F3BA. O cálculo do índice de maturação do colágeno e determinação da força de ruptura (FRT) e força máxima de tração (FMT), foi testada em tensiômetro computadorizado. Utilizou-se para análise estatística, os testes t de Student e Kruskal-Wallis com nível de significância de P&lt;0,05. RESULTADOS: Na avaliação do colágeno imaturo não houve diferença estatisticamente significativa. Quanto ao maduro, no grupo controle, houve maior percentual no subgrupo do 7º dia pós-operatório (21,43±1,06 vs.11,26±1,44, P=0,0000). No grupo octreotide, não houve diferença entre os subgrupos. Na avaliação inter-grupos do colágeno maduro, a dosagem foi maior no 4º dia do pós-operatório do grupo octreotide (19,13±1,38 vs.11,26±1,44, P=0,001). O índice de maturação do colágeno maior para o grupo octreotide no 4º dia do pós-operatório (1,07±0,07 vs. 0,65±0,05, P=0,0001). A FMT e a FRT não apresentaram diferença entre os grupos. CONCLUSÕES: A administração de octreotide por via subcutânea aumenta a deposição de colágeno maduro e não altera a resistência tênsil de gastrorrafias em ratos.

A case of persistent hyperinsulinemic hypoglycemia of infancy successfully managed with subcutaneous octreotide injection and nocturnal intravenous glucose supply.

Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is often resistant to medical therapy and is normally treated by subtotal pancreatectomy to avoid neurological complications. However, many problems after surgery, such as recurrence of hypoglycemia and diabetes mellitus, remain to be solved. This report concerns a case of PHHI that was resistant to octreotide or diazoxide alone but was successfully controlled with subcutaneous injection of octreotide in combination with nocturnal glucose infusion through central venous catheter. The patient exhibited natural remission of hyperinsulinism with age, and all treatment was ceased at the age of 4 yr. Growth and neurological development of the patient have been normal. This combined therapy can be a therapeutic option as a substitute for surgical solutions.

A Case of Successful Management of Sarcoidosis with Chylothorax Using Octreotide

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid. (Tuberc Respir Dis 2007; 62: 119-124)

Medical Treatment of Benign Insulinoma Using Octreotide LAR: A Case Report

In some patients with insulinoma, surgery is not possible due to either difficulties in detecting the tumor or advanced age. These patients need medical treatment for hypoglycemia. We report a case of benign insulinoma using the long-acting octreotide formulation, octreotide long-acting repeatable (octreotide LAR), as a medical therapy. A 67-year-old woman was referred to our hospital for examinations of hypoglycemia. A blood sample taken during a hypoglycemic episode revealed low plasma glucose concentration, hyperinsulinemia and a high C-peptide level. An abdominal CT scan demonstrated a hypervascular tumor in the body of pancreas. She was diagnosed with insulinoma. As the patient refused surgical resection of the pancreas tumor, we started to use the somatostatin analogue, octreotide, for treatment of hypoglycemia. After the treatment her plasma glucose levels were elevated and serum immunoreactive insulin (IRI) levels were decreased. For long-term treatment, we changed the treatment from daily subcutaneous injection of octreotide to monthly intramuscular administration of octreotide LAR. This treatment was also effective and hypoglycemic attacks disappeared. Both plasma glucose levels and serum IRI levels were improved. Our case demonstrated that octreotide LAR was useful for long-term medical treatment of insulinoma.