Octreotide as Adjunctive Therapy for Catecholamine-Secreting Pheochromocytoma and Paraganglioma

CONTEXT: Catecholamine-secreting pheochromocytomas and paragangliomas (PPGLs) can be difficult to stabilize before surgery or during follow-up. Somatostatin receptor expression provides a rationale for octreotide therapy, but clinical evidence is limited. OBJECTIVE: To evaluate biochemical, clinical, hemodynamic, metabolic, and perioperative outcomes associated with octreotide treatment in catecholamine-secreting PPGLs. METHODS: We retrospectively studied 27 consecutive patients with PPGLs treated with octreotide at two referral centers in Muscat, Oman between January 2012 and March 2026. Primary outcomes were clinical, hemodynamic and biochemical responses; secondary outcomes included glycemic, surgical, and follow-up outcomes. RESULTS: Twenty-seven patients were included (70.4% female; mean age, 50.3 ± 22.2 years); 14 had paraganglioma and 13 pheochromocytoma. All received long-acting octreotide, and 10 also received short-acting octreotide. Median plasma norepinephrine decreased from 6,723 to 1,901 pmol/L (P < 0.0001). Epinephrine, dopamine, and chromogranin A also decreased significantly. Mean blood pressure decreased from 154.8/93.5 to 123.0/75.3 mmHg (n = 16; P = 0.0003 for systolic and P = 0.0006 for diastolic pressure), and mean HbA1c decreased from 8.6 ± 2.4% to 6.2 ± 0.8% among patients with diabetes (n = 11; P = 0.005). Seventeen patients underwent surgical resection. During a median follow-up of 3 years, one non-PPGL-related death occurred. CONCLUSIONS: Octreotide treatment was associated with biochemical, hemodynamic, and metabolic improvement and may serve as a useful adjunct in selected patients, particularly as a bridge to surgery and during perioperative preparation.