Treatment of diabetic diarrhea and orthostatic hypotension with somatostatin analogue SMS 201–995

A diabetic patient was treated with a somatostatin analogue, SMS 201–995, to control chronic diarrhea and orthostatic hypotension. The patient was injected with 50 μg, 100 μg, and 150μg of SMS 201–995 subcutaneously twice daily for three days at each dose. Stool weight decreased from a basal mean value of 906 g per 24 hours to 628 g, 445 g, and 408 g per 24 hours, respectively. Diarrhea remained suppressed for 18 months when the patient was last seen. When SMS 201–995 was then given at 5 μg to 10 μg per hour by continuous subcutaneous infusion, stool weight decreased to a mean of 321 g per 24 hours. Basal blood pressure, which averaged 99/71 mm Hg, rose to 13391 mm Hg five minutes after 75 μg of SMS 201–995 was injected subcutaneously; it remained elevated for six hours after injection. Serum motilin levels decreased significantly from 126 pg/ml before injection of SMS 201–995 to 52 pg/ml after injection. Serum norepinephrine levels rose from 50 pg/ml supine (normal range, 150 to 550 pg/ml) and 52 pg/ml erect before injection of SMS 201–995 to 72 pg/ml supine and 110 pg/ml erect after injection. SMS 201–995 may raise blood pressure, in part by increasing the release of circulating norepinephrine.