Abstract
Gut tumor syndromes are rare, occurring in less than two cases per million population per year: Insulinomas are most common and gastrinomas are less common; all the others are extremely rare. Conventional treatment of the symptoms caused by these tumors has included surgery, hepatic arterial embolization, and chemotherapy; some patients with Zollinger-Ellison syndrome (ZES) have been treated with specific agents such as gastric antisecretory drugs. The development of octreotide, a synthetic, long-acting analogue of the natural peptide somatostatin, has offered an alternative to such therapies. Octreotide has a half life of >100 minutes and inhibits both physiological- and tumor release of many peptides. It also has direct effects on the gut that modify secretion and motility. Octreotide has been shown to be particularly useful for the symptoms of tumors producing vasoactive intestinal peptide (VIP), and of the carcinoid syndrome. It is also useful in patients with glucagonomas, with growth hormone-releasing hormone producing tumors, and in some patients with Cushing's syndrome and unresectable insulinomas. Octreotide is effective in patients with ZES, but alternative therapies such as omeprazole are more effective, safer, and more convenient for those patients. Side effects of octreotide have not been troublesome in these patients, but the incidence of long term effects is still not entirely clear. Octreotide has proved to be a significant advance in the treatment of patients with islet cell tumors.
Résumé
Les auteurs présentent les avantages et les inconvénients de l'octréotide acétate dans le traitement de certaines tumeurs insulaires du pancréas telles que les insulinomes, les gastrinomes, les VIPomes et les glucagonomes. L'utilité de ce médicament dans le traitement du syndrome carcinoïde, du syndrome de Cushing et des tumeurs à ACTH et les effets secondaires de l'octréotide acétate sont abordés.
Resumen
Los diferentes tipos de tumores derivados de las células insulares del páncreas, que producen variados síndromes clínicos, son imposibles de distinción histológica y se clasifican mas bien según su principal producto tumoral circulante y según los hallazgos clinicos. Taies tumores incluyen los que producen principalmente insulina (insulinomas), gastrina (gastrinomas), péptido intestinal vasoactivo (vipomas), glucagón (glucagonomas), somatostatina (somatostatinomas), serotonina (carcinoides y el síndrome carcinoide), hormona liberadora de hormona del crecimiento (HLHComas, o GHRHomas en inglés), ACTH (sindrome de Cushing ectópico) o factores humorales hipercalcémicos. Raramente los tumores de células insulares secretan solamente neurotensina (neurotensinomas) o polipéptido pancreático (PPomas), que no producen síndromes clinicos, y se agrupan con aquellos tumores que se clasifican como de tipo neuroendocrino por microscopía de luz pero que no liberan productos detectables y que se conocen como “tumores no funcionantes”. Muchos neoplasmas neuroendocrinos secretan más de un péptido (por ejemplo VIP y PP o gastrina ACTH) y pueden contener uno o más péptidos detectables por inmunocitoquímica. En tales casos los tumores se clasifican según el síndrome clínico dominante. Cualquiera de los tumores de células insulares puede presentarse como tumor esporádico o como parte del sindrome familiar de neoplasia endocrina múltiple tipo I. Puesto que los tumores de células insulares con frecuencia son de crecimiento lento, el tratamiento de los síntomas que produce la liberación de productos biológicamente activos a la circulación es de importancia; en efecto, tales neoplasmas pueden producir síntomas severos cuando todavía no han dado metástasis, y los pacientes pueden sucumbir como consecuencia de los péptidos más que por el crecimiento tumoral. Por otra parte, la abolición de los sintomas paraneoplásicos puede lograr el bienestar del paciente, aún en presencia de metastasis extensas.
Los autores presentan los pros y contras del uso del acetato de octreótido en casos de tumores de células insulares específicos, incluyendo insulinomas, gastrinomas, VIPomas y gloucagonomas. Además, discuten la utilidad de este agente en el síndrome carcinoide, el síndrome de Cushing y en tumores productores de hormona liberadora de hormona del crecimiento. Se revisan los efectos colaterales del octreótido y otros asuntos pertinentes aún no resueltos.
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Maton, P.N. Use of octreotide acetate for control of symptoms in patients with islet cell tumors. World J. Surg. 17, 504–510 (1993). https://doi.org/10.1007/BF01655110
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DOI: https://doi.org/10.1007/BF01655110