Snapshot A 40-year-old man with a past medical history of headaches presents to his primary care physician for persistent headaches and changes in his face. He reports that he can no longer fit his caps, his jaw seems larger, and there is increased spacing between his teeth. He reports some numbness and tingling in his hands. His physician orders an IGF1 test, which screens for acromegaly. This test comes back positive and an oral glucose load confirms the diagnosis of acromegaly. He is started on octreotide while he awaits imaging evaluation of his brain. Introduction Drugs octreotide Mechanism of action octreotide is a somatostatin analog inhibits secretion of splanchnic vasodilatory hormones growth hormone gastrin vasoactive intestinal peptide (VIP) glucagon secretin serotonin pancreatic polypeptide Clinical use acute variceal bleeds acromegaly VIPoma carcinoid tumors glucagonoma other neuroendocrine tumors Adverse effects gastrointestinal upset steatorrhea inhibits cholecystokinin, which increases the risk of cholelithiasis and cholecystitis bradycardia