Severe impairment of postprandial cholecystokinin release and gall-bladder emptying and high risk of gallstone formation in acromegalic patients during Sandostatin LAR.
BACKGROUND
Acromegalic patients treated three times daily with subcutaneous injections of the somatostatin analogue octreotide frequently develop gallstones, due to suppressed cholecystokinin release and impaired gall-bladder emptying.


OBJECTIVE
To elucidate the effects of a new long-acting octreotide formulation (Sandostatin LAR) on gall-bladder emptying, cholecystokinin release and gallstone formation.


METHODS
Postprandial gall-bladder and gastric emptying were determined by ultrasonography and cholecystokinin release was measured in seven patients on days 0, 14, 28, and 75 (Sandostatin LAR, 20 mg intramuscularly on days 1, 30, and 60).


RESULTS
During treatment, fasting gall-bladder volumes increased from 26.5 +/- 3.2 mL to 61.4 +/- 7.5 mL, but postprandial cholecystokinin release and gall-bladder emptying (from 63.9 +/- 3.8% to 12.3 +/- 3.5%) were severely suppressed. Gallstones formed in six out of seven patients within 8 months of treatment. Gastric emptying did not change during the therapy.


CONCLUSIONS
The risk of gallstone formation is greatly increased during Sandostatin LAR. This is probably related to profound suppression of cholecystokinin release and gall-bladder emptying.
Moschetta
A
A
Department of Gastroenterology, University Medical Center Utrecht, the Netherlands.
Stolk
M F
MF
Rehfeld
J F
JF
Portincasa
P
P
Slee
P H
PH
Koppeschaar
H P
HP
Van Erpecum
K J
KJ
Vanberge-Henegouwen
G P
GP
D000172:Acromegaly / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D002626:Chemistry, Pharmaceutical; D002766:Cholecystokinin / Q000378:metabolism*; D002769:Cholelithiasis / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D016473:Gallbladder Emptying / Q000187:drug effects* / Q000502:physiology; D005765:Gastrointestinal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000009:adverse effects* / Q000627:therapeutic use; D019518:Postprandial Period / Q000187:drug effects; D012307:Risk Factors
D005765:Gastrointestinal Agents; D002766:Cholecystokinin; D015282:Octreotide