Night blindness in a haemodialysed ADPKD patient receiving octreotide

A 62-year-old woman on chronic haemodialysis since November 2008 for end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD) had developed a massive polycystic liver (10.647 mL), causing severe abdominal discomfort, early satiety, dyspepsia and dyspnoea (Figure 1). On the basis of the demonstrated effectiveness of somatostatin analogues in reducing the liver volume in ADPKD patients [1, 2] and taking into account her reluctance for any liver surgery, we offered her a trial treatment with octreotide. We administered a single-test dose of short-acting subcutaneous 100 μg octreotide and observed the patient over a 24-h period. Diarrhoea, vomiting and abdominal cramps occurred several hours after administration, but disappeared the day after. We then started long-acting octreotide treatment at a monthly dose of 20 mg. A few hours after the injection, the patient suffered from diarrhoea, nausea and vomiting. While nausea and vomiting rapidly resolved, diarrhoea persisted over the whole next month. Thus, the monthly dose of octreotide was reduced to 10 mg. After 3 months of treatment, diarrhoea persisted with fatty and discoloured stools. At the same time, the patient began to report loss of nocturnal peripheral vision. She explained that, in the dark, her visual field was restricted, giving her the feeling of seeing ‘like in a tunnel’.