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Douleur et Analgésie

, Volume 15, Issue 3, pp 163–168 | Cite as

Algies vasculaires de la face associées à une acromégalie et soulagées par la somatostatine

Deux observations
  • M. Cheynet
  • R. Peyron
  • M. L. Navez
  • B. Laurent
Article
  • 24 Downloads

Résumé

2 patients acromégales souffrant d’algies vasculaires de la face (AVF) sont soulagés par l’injection d’ocréotide (somatostatine de synthèse). Cette association d’AVF, d’acromégalie et de sensibilité à la somatostatine n’est pas publiée et conduit à envisager de nouvelles hypothèses pathogéniques pour l’AVF. Nos patients avaient bénéficié d’une exérèse complète d’un macro-adénome à GH qui n’est donc pas responsable de la symptomatologie par un mécanisme compressif. L’association syndromique AVF et acromégalie est probablement fortuite mais l’effet bénéfique de la somatostatine sur les crises d’AVF pose plusieurs questions: est ce un rôle antalgique général du peptide qui est bien documenté, est ce l’intervention sur le sommeil ou est ce l’effet vasculotrope authentique de la somatostatine...? Notre hypothèse est que la somatostatine jouerait sur les processus vasculaires et inflammatoires présents au niveau du sinus caverneux au cours des crises d’AVF. L’effet pourrait être comparable à celui des médicaments à impact sérotoninergique, tant dans l’effet bénéfique sur la crise que dans la dépendance qui se développe au long cours chez les deux patientes.

Mots-clés

AVF acromégolie somatostatine serotonine sommeil douleur 

Abréviations

AVF

Algie Vasculaire de la Face

IRM

Imagerie par Résonance Magnétique

SST

Somatostatine

GH

Growth Hormone

IGF

Insuline Like Growth Factor

PRL

Prolactine

CGRP

Calcitonin Gene Related Peptide

SRIF

Somatotrophin Release Inhibiting Factor

REM sleep

Rapid Eyes Movement Sleep

SAS

Syndrome d’Apnée du Sommeil

Summary

We describe 2 patients diagnosed with acromegaly presented cluster headache (CH) that responded to subcutaneous injections of octreotide (somatostatin synthetic analogue). That association of CH with acromegaly and the fact that CH improves with somatostatin is unpublished. This work has led us to find explanations according to the semiology of these patients and to the literature of the somatostatin effects. Our patients had a complete tumorectomy of their macro adenoma, therefore we considere that it was not the cause of their CH. Other hypothesis could be proposed: First, somatostatin itself has an analgesic effect that has been already described but not in CH. A second hypothesis is that somatostatin would be a neuromediator that takes place in sleep regulation equally involved in pathogenis of CH. The third hypothesis is vascular and inflammatory; these processes occur in the cavernous sinus during cluster headache attacks according to the trigemino-vascular hypothesis. Treatments for cluster headache, especialy the triptan act on that inflammatory process of carotid as the somatostatin which possess a vascular tropism. That interpretation of somatostatin may explain the improvement of CH in our cases with occurrence of dependance and addiction.

Key-words

Cluster Headache acromegaly somatostatin serotonine sleep pain 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • M. Cheynet
    • 1
  • R. Peyron
    • 1
  • M. L. Navez
    • 1
  • B. Laurent
    • 1
  1. 1.Hôpital Bellevue, Service de NeurologieCHUSt Etienne

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