Octreotide, a long-acting
somatostatin analogue has recently been introduced in the
therapy of gastroenteropancreatic endocrine
tumors, but home experience has been lacking. With the aim of drawing attention to this therapeutic possibility, a case of
malignant carcinoid syndrome treated with
octreotide for 18 months is reported. Despite the therapeutic attempts preceding the
octreotide administration a gradual progression in clinical symptoms was observed and
cardiac failure due to fibrotic and
valvular heart disease developed. Cytotoxic
chemotherapy,
serotonin antagonists or repeated selective embolisation of the hepatic artery only resulted in a short transitional improvement.
Octreotide in a dose of 100 micrograms three times daily by
subcutaneous injection provided effective and rapid relief from episodic
flushing and serious diarrhoea. Plasma level of
serotonin and 24-hour urinary excretion of 5-hydroxyindolacetic
acid decreased from 6 micrograms/ml to 2 micrograms/ml and from 800 mumol/day to 70 mumol/day, respectively. No changes in the number and extension of liver
metastases could be seen after introducing the
octreotide treatment. The patient's compensated cardiac status could be preserved and continuous
therapy provided an acceptable quality of life.