Subject(s)
Bacteremia/microbiology , Flavobacteriaceae Infections/microbiology , Flavobacterium/isolation & purification , Aged, 80 and over , Anemia, Megaloblastic/complications , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Cardiovascular Diseases/complications , Disease Susceptibility , Drug Resistance, Multiple, Bacterial , Drug Substitution , Female , Flavobacteriaceae Infections/drug therapy , Flavobacterium/drug effects , Humans , Kidney Failure, Chronic/complications , Leg , Obesity/complications , Skin Diseases, Infectious/complicationsABSTRACT
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.
Subject(s)
Acromegaly/complications , Heart Failure/surgery , Heart Transplantation , Adult , Heart Failure/drug therapy , Heart Failure/etiology , Humans , Male , Octreotide/therapeutic useABSTRACT
Dilated cardiomyopathy associated with acromegaly is rare, but may improve with octreotide, a somatostatin analogue. The authors give the first description here of paradoxical worsening in cardiac function during such treatment, with the onset of episodes of acute decompensation following each attempt at starting treatment. Thus worsening was confirmed objectively by a challenge test with octreotide: increased dyspnea, fall in shortening fraction and in echocardiographic cardiac output (of 17 to 14% and 4 to 3 l/min respectively), a decrease in isotopic ejection fraction from 15 to 6% and this in parallel with efficacy regarding hormone levels of GH and IGF1 and a reduction in tumour size by CT scan. No further episode of decompensation occurred after treatment was stopped permanently. The patient underwent a transplant 3 months later. Suppression of the positive inotropic effect of GH by octreotide, associated with an increase in peripheral resistance is suggested. A negative inotropic effect of this hormonal analogue on too advanced a case of heart disease is also a possibility.
