Somatostatin analogs and gallstones: A retrospective survey on a large series of acromegalic patients

• Published in: Journal of endocrinological investigation Vol. 31; no. 8; pp. 704 - 710
• Main Authors: Attanasio, R., Mainolfi, A., Grimaldi, F., Cozzi, R., Montini, M., Carzaniga, C., Grottoli, S., Cortesi, L., Albizzi, M., Testa, R. M., Fatti, L., De Giorgio, D., Scaroni, C., Cavagnini, F., Loli, P., Pagani, G., Ghigo, E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.08.2008
• Subjects: Acromegaly - complications; Acromegaly - drug therapy; Adult; Cohort Studies; Dyslipidemias - complications; Dyslipidemias - epidemiology; Endocrinology; Female; Follow-Up Studies; Gallstones - chemically induced; Gallstones - epidemiology; Human Growth Hormone - secretion; Humans; Male; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Obesity - complications; Obesity - epidemiology; Original Articles; Prevalence; Retrospective Studies; Risk Factors; Somatostatin - adverse effects; Somatostatin - analogs & derivatives; Somatostatin - therapeutic use; Acromegaly; GH; IGF-I; somatostatin analogs; gallstones
• ISSN: 0391-4097; 1720-8386
• DOI: 10.1007/BF03346419

Context : Development of gallstones (GS) is reported during the use of somatostatin analogs (SA) that are at present the mainstay for the medical treatment of acromegaly. Objective : To review the prevalence and clinical and biochemical correlates of GS in acromegalic patients. Design and seting : Retrospective survey on hospital records in acromegalic patients followed up in the last 20 yr in tertiary referral centers. Patients : Four hundred and fifty-nine patients (272 females). Main outcome measures : According to SA use and GS occurrence, patients were divided in 4 groups: 1) treated with SA without GS (SA+GS−), 2) GS developed while on SA (SA+GS+), 3) GS without SA use (SA−GS+), 4) neither GS nor SA (SA−GS−). Results : Patients were unevenly distributed in the 4 groups: 232, 125, 38, 64, respectively, pointing to a prevalence of GS in acromegaly of 8.3% at diagnosis with an additional 35% developing GS during SA. GS occurred after 3 months-18 yr (median 3 yr) of SA treatment, were diagnosed after symptoms in 17.6%, were associated to steatosis, ultrasound biliary dilation, and biochemical cholestasis, in 25.6%, 12.8%, and 4% of patients, respectively. Ursodehoxicolic acid was administered after GS occurrence, causing their dissolution in 39% of patients after 3–48 months (median 12). Cholecystectomy was performed in 16.8% of patients in group 2. At multivariate analysis obesity, dyslipidemia, and SA treatment were independent predictors of GS onset, whereas gender and age were not. Conclusions : GS are a frequent occurrence in acromegalic patients treated with SA, may occur at any time, but are seldom symptomatic or prompt acute surgery. Obesity and dyslipidemia appear to play a major role in the occurrence of GS in acromegalic patients on SA treatment.