Serum growth hormone (GH), insulin-like growth factor I (IGF-I), calcium, phosphate, osteocalcin, and intact parathormone (PTH) were measured in 10 patients with active acromegaly before and after 1, 6, and 12 months of treatment with octreotide (50 to 100 μg subcutaneously TID). Serum GH and IGF-I decreased after 1 month, and this effect was maintained at 6 and 12 months. A transient decrease in calcium and a persistent decrease in osteocalcin were also seen. Before treatment, calcium, phosphate, and osteocalcin levels were higher in the patients with acromegaly than in the 25 healthy controls; at 12 months, only the phosphate levels remained higher than baseline in the acromegalic patients. The levels of PTH were comparable in both groups before treatment, but were elevated in the patients with acromegaly after treatment. The lower calcium and osteocalcin levels recorded during octreotide treatment are similar to those seen after pituitary adenomectomy, but the phosphate and PTH values suggest that octreotide exerts further actions on calcium homeostasis. In addition to the reduced 1,25-dihydroxyvitamin D synthesis caused by the lowered GH levels, octreotide might cause intestinal malabsorption of calcium, which consequently stimulates PTH secretion.

We report on a patient suffering a spontaneous hemorrhage primarily located in the right brain-stem; surgical correction of this led to a substantial improvement in clinical deficits. Brain-stem auditory evoked potentials (BAEPs) were recorded on postoperative days 18, 30, 55 and 205. Waves II through V were initially undetectable on stimulation of the damaged side, whereas the absence of peak V was the only abnormality seen on left-side stimulation. With the regression of the right lower mid-pontine deficits, the right waves gradually reappeared and normalized progressively. On the last recording, only a left wave V abnormality persisted. At that time, the patient had a moderate left hemisyndrome due to a circumscribed right upper pontine-midbrain lesion. Therefore, it can be suggested that the first 4 waves of BAEPs mainly originate in the ipsilateral pons, and the Vth in the contralateral higher regions.