Endocrine Abstracts

Somatostatin may act as a neurotransmitter in the neural network. It`s associated with a possible long-term effect on calcium channels and, as a result, on the membrane potential of the cell. Bradycardia due to somatostatin analogues’ use could be a clinical demonstration of such effect. We would like to present a clinical case of a female patient with acromegaly and possible positive effect of octreotide treatment on concomitant epilepsy. From 2000 (age 40) a woman noted swelling of the face, a slow increase in the size of the hands and feet, hyperhidrosis, but she did not pay much attention to these signs. In 2011 (age 51) she noted episodes of loss of consciousness and convulsive seizures that why she referred for medical help. Endocrinologists recognized clinical signs of acromegaly. According to brain MRI pituitary macroadenoma (4.5x3.0x6.0 cm, V 38.7 cm3) with latero-suprasellar extension and the frontal lobe of the right hemisphere invasion was revealed. IGF-1 levels were 829 ng/ml (56-261) so active acromegaly was diagnosed, epilepsy was considered as secondary condition due to giant adenoma. Debulking surgery with consequent radiosurgery (Novalis) of the residual tumor was performed. Then she received octreotide prolonged release 30 mg monthly and achieved biochemical control. At the same time with acromegaly treatment, she started anticonvulsant therapy with valproic acid (1200 mg daily) and convulsive symptoms disappeared. Till February 2021 (age 61) she was stable, and octreotide was withdrawn, IGF-1 without treatment 118-159 ng/ml (43-220). Since April 2021 she noticed convulsive syndrome again despite the continuous use of valproic acid. Neurologist recommended to continue valproic acid at the same dose, however, convulsive symptoms occurred.

In this case, we suggested that treatment with somatostatin analogues was associated with absence of convulsive symptoms in acromegaly patient with lesion-induced epilepsy. We cannot exclude that withdraw of possible positive effect of somatostatin analogues on ion channels disorders resulted in epilepsy relapse, which requires further study of additional therapeutic properties of drugs in this group.