Heart transplantation for terminal congestive heart failure in an acromegalic patient.

Dilated hypokinetic cardiomyopathy in an acromegalic patient is an uncommon event. Specific hormonal therapy with octreotide (a somatostatin analogue) is now recognized as able to improve cardiac failure. A case of worsening of cardiac function under such a therapy is described in this report. Octreotide was finally discontinued and a cardiac transplantation performed. Soon after surgery, treatment with octreotide was started again and no other adverse reaction was noticed. Furthermore, no deleterious or synergistic interaction between the somatostatin analogue and cyclosporine A was detected. A pharmacological hypothesis is given to explain the inability of octreotide to counteract cardiac failure. The patient died 6 months after surgery probably because of an acute episode of arrhythmia.