Hemodynamic Effects of Octreotide in Patients With Autonomic Neuropathy

BackgroundThe somatostatin analogue, octreotide, is being used to treat postprandial hypotension in patients with autonomic neuropathy. Although the therapeutic effect of the drug is presumably secondary to a splanchnic vasoconstrictor action, its effect on splanchnic hemodynamics has never been characterized in patients with autonomic neuropathy. Moreover, is unknown whether octreotide acts on other vascular beds in this group of patients or whether it affects cardiac output. We, therefore, measured splanchnic, forearm, and systemic vascular resistance and cardiac output before and after administering octreotide (0.4 μg/kg s.c.) to patients with idiopathic autonomic neuropathy and diabetic autonomic neuropathy. Methods and ResultsSplanchnic blood flow was determined from the clearance of indocyanine green in seven patients. We observed that octreotide decreased splanchnic blood flow (from 850±77 to 664±48 ml/min, p < 0.005), increased mean blood pressure (from 97±6 to 115±3 mm Hg, p < 0.005), and increased splanchnic vascular resistance (from 0.118±0.012 to 0.18 ±0.018 mm Hg/ml/min, p < 00.005). Forearm blood flow was measured by plethysmography in 13 patients. Octreotide increased forearm vascular resistance in patients with idiopathic autonomic neuropathy (n =8) from 19.1 ± 1.0 to 27.2±3.8 mm Hg/ml/min/100 ml forearm volume (p < 0.01) and from 25.2±3.9 to 41.0±6.8 mm Hg/ml/min/100 ml (p < 0.01) in patients with diabetic autonomic neuropathy (n =5). Cardiac output was measured by two-dimensional echocardiography. Octreotide administration increased cardiac output in five of six patients with idiopathic autonomic neuropathy (from 4.4 0.4 to 5.0 ± 0.5 1/min, p < 0.02) and five of five patients with diabetic autonomic neuropathy (from 3.8 ± 0.4 to 5.1 ± 0.4 1/min, p < 0.02). Systemic vascular resistance increased in patients with idiopathic autonomic neuropathy from 21.2±2 to 24.9±2.6 (p < 0.05) but did not change in patients with diabetic autonomic neuropathy. ConclusionsThe pressor effect of octreotide in patients with autonomic neuropathy is associated with increased splanchnic and forearm vascular resistance and with increased cardiac output. (Circulation 1991;84:168–176)

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