Withdrawal of somatostatin analogue therapy in patients with acromegaly is associated with an increased risk of acute biliary problems.
Paisley, Angela N Roberts, Margaret E Trainer, Peter J
Paisley, Angela N
Roberts, Margaret E
Trainer, Peter J
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Abstract
BACKGROUND: The prevalence of gallstones (GS) is increased in acromegaly and further increased by somatostatin analogue (SA) therapy. The incidence is reported at 10-63%, but they are often asymptomatic and rarely require definitive management. Evidence suggests discontinuation of SA may precipitate acute biliary problems. OBJECTIVE: To determine the frequency of symptomatic gallstones in patients treated with SA. DESIGN: Retrospective analysis of prospectively followed patients in our centre. RESULTS: Fifty patients (30 male, mean age 54 +/- 16 years) were on treatment with SA on 1 January 2003. Fifteen (11 male, mean age 50 +/- 17 years) have since discontinued SA with three proceeding to develop acute cholecystitis and two, biliary colic necessitating cholecystectomy. Three of the five had abnormal liver enzymes at or within 3 months of symptomatic presentation. Two of the remaining 35 patients experienced biliary colic necessitating cholecystectomy. These data indicate a highly significant increase in acute biliary problems on discontinuing SA (5 in 27.67 patient 'off-treatment' years vs. 2 in 299 patient treatment years, chi(2), P < 0.0001). All seven patients experiencing problems were male (P = 0.01). CONCLUSION: This analysis demonstrates the high incidence of symptomatic GS following SA withdrawal, particularly in men. Although liver enzymes were raised no common abnormality was evident to aid as a predictor of future symptoms. We recommend all patients due to stop SA be forewarned of the risk of acute biliary problems. Further work is required to confirm if there is a gender-related difference in the incidence of acute biliary problems on discontinuing SA therapy.
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2007-05
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Withdrawal of somatostatin analogue therapy in patients with acromegaly is associated with an increased risk of acute biliary problems. 2007, 66 (5):723-6 Clin. Endocrinol.