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 setting: 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 7.6%, 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.

Somatostatin analogs and gallstones : a retrospective survey on a large series of acromegalic patients / R. Attanasio, A. Mainolfi, F. Grimaldi, R. Cozzi, M. Montini, C. Carzaniga, S. Grottoli, L. Cortesi, M. Albizzi, R. Miranda Testa, L. Fatti, D. De Giorgio, C. Scaroni, F. Cavagnini, P. Loli, G. Pagani, E. Ghigo. - In: JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION. - ISSN 0391-4097. - 31:8(2008), pp. 704-710.

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

R. Attanasio
Primo
;
C. Carzaniga;L. Fatti;F. Cavagnini;
2008

Abstract

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 setting: 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 7.6%, 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.
Acromegaly; Gallstones; GH; IGF-I; Somatostatin analogs
Settore MED/13 - Endocrinologia
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/50079
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