title: Hepatolithiasis (intrahepatic stone) during octreotide therapy for acromegaly: a case report.
abstract: We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis during octreotide therapy. Gallstones and bile sludge are common side effects of octreotide therapy but rarely become symptomatic or require treatment. Hepatolithiasis is uncommon in western countries but is quite prevalent in East Asia and is often associated with a predisposing condition that causes intrahepatic bile stasis (eg. bile duct stricture). In addition to its known effect on gallbladder stasis, octreotide alters bile acid composition and may thus hasten intrahepatic sludge and stone formation. Extra caution should be taken in using octreotide or its long-acting analog in patients otherwise predisposed to intrahepatic bile stasis.
authors.affiliation: Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Sheehan
authors.forename: T B
authors.initials: TB
authors.lastname: Nippoldt
mesh_terms: D015746:Abdominal Pain; D000172:Acromegaly / Q000188:drug therapy*; D000236:Adenoma / Q000601:surgery; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001653:Bile Ducts, Intrahepatic; D001663:Bilirubin / Q000032:analysis; D000077465:Cabergoline; D056486:Chemical and Drug Induced Liver Injury; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D002784:Cholesterol / Q000032:analysis; D004873:Ergolines / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections; D006498:Hepatectomy; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008099:Liver / Q000293:injuries / Q000601:surgery; D008107:Liver Diseases / Q000175:diagnosis / Q000601:surgery; D008297:Male; D015282:Octreotide / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D013530:Surgical Wound Infection / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D004873:Ergolines; D007334:Insulin-Like Growth Factor I; D002784:Cholesterol; D000077465:Cabergoline; D001663:Bilirubin; D015282:Octreotide