Invitti C, Fatti L, Camboni M G, Porcu L, Danesi L, Delitala G, Cavagnini F
Cattedra di Endocrinologia II, Università di Milano, IRCCS Ospedale San Luca, Italy.
J Endocrinol Invest. 1996 Sep;19(8):548-55. doi: 10.1007/BF03349015.
Octreotide nasal powder is a delivery system of the somatostatin analogue developed to overcome the inconvenience of repeated subcutaneous administrations. Eight patients with clinically active acromegaly were treated for three months with octreotide nasal powder which was administered at the initial dosage of 0.125 mg tid, doubling the dosage up to 2 mg tid in order to obtain a mean GH value below 5 micrograms/l during 8 daytime hours. In 4 of these patients, treatment was prolonged till the sixth month. Blood samples were taken on days 15, 29, 43, 55, 90, 120, 150, 180 for GH, IGF-I, IGFBP-3, IGFBP-1 and insulin measurements. Before treatment, mean daytime GH and morning IGF-I serum levels were both increased but not correlated with each other. Serum IGFBP-3 levels were higher than normal and positively correlated with those of GH, IGF-I and insulin. Insulin levels were elevated and positively correlated with those of GH but not with those of IGF-I and IGFBP-1. Serum IGFBP-1 levels were in the low normal range and not correlated with any of the other parameters. Treatment with octreotide nasal powder induced in all patients a marked decrease of GH which lowered below 5 micrograms/l in 7/8 patients and IGF-I levels, which fell within the normal range in 1 patient. Serum IGFBP-3 and insulin concentrations decreased by 26% and 71%, respectively, and those of IGFBP-1 underwent an only transient increase in 5/8 patients. Opposite changes of insulin and IGFBP-1 levels, with a decrease of the former followed by an increase of the latter were noted during the 8 hours following an octreotide nasal insufflation. During chronic octreotide treatment, positive correlations were found between GH and IGF-I, GH and IGFBP-3, IGF-I and IGFBP-3, insulin and IGFBP-3 and insulin and IGF-I. An improvement of the clinical picture was registered in all patients after a few days of octreotide nasal powder administration. Treatment was well tolerated, with only mild side effects and no significant changes in the nasal mucosa, and the patients' compliance was excellent.
奥曲肽鼻粉是一种生长抑素类似物的给药系统，旨在克服反复皮下注射带来的不便。8例临床活动期肢端肥大症患者接受奥曲肽鼻粉治疗3个月，初始剂量为0.125mg，每日3次，剂量加倍至2mg，每日3次，以便在8个白天时段内使平均生长激素（GH）值低于5μg/L。其中4例患者治疗延长至6个月。在第15、29、43、55、90、120、150、180天采集血样，检测GH、胰岛素样生长因子-I（IGF-I）、胰岛素样生长因子结合蛋白-3（IGFBP-3）、胰岛素样生长因子结合蛋白-1（IGFBP-1）和胰岛素。治疗前，平均白天GH和早晨血清IGF-I水平均升高，但彼此无相关性。血清IGFBP-3水平高于正常，且与GH、IGF-I和胰岛素水平呈正相关。胰岛素水平升高，与GH水平呈正相关，但与IGF-I和IGFBP-1水平无关。血清IGFBP-1水平处于低正常范围，与其他任何参数均无相关性。奥曲肽鼻粉治疗使所有患者的GH显著降低，8例患者中有7例低于5μg/L，IGF-I水平降低，1例患者降至正常范围内。血清IGFBP-3和胰岛素浓度分别降低26%和71%，8例患者中有5例的IGFBP-1水平仅出现短暂升高。在奥曲肽鼻内给药后的8小时内，观察到胰岛素和IGFBP-1水平的相反变化，前者降低后后者升高。在慢性奥曲肽治疗期间，发现GH与IGF-I、GH与IGFBP-3、IGF-I与IGFBP-3、胰岛素与IGFBP-3以及胰岛素与IGF-I之间存在正相关。在给予奥曲肽鼻粉几天后，所有患者的临床症状均有改善。治疗耐受性良好，仅有轻微副作用，鼻黏膜无明显变化，患者依从性极佳。
