title: Drug-induced hepatitis in an acromegalic patient during combined treatment with pegvisomant and octreotide long-acting repeatable attributed to the use of pegvisomant.
abstract: We report on a patient with acromegaly who developed severe drug-induced hepatitis during combined treatment with the long-acting somatostatin-analog octreotide and the GH receptor antagonist pegvisomant. The hepatic enzyme disturbances normalized after discontinuation of pegvisomant. After rechallenge with monotherapy pegvisomant, however, the hepatic enzyme disturbances reappeared within a few weeks, indicating that most likely pegvisomant alone and not the long-acting somatostatin analog or the combination of these two drugs was responsible for this case of drug-induced hepatitis. Clinicians should be aware of this potential severe adverse drug reaction and therefore frequent control of hepatic enzymes is mandatory during treatment with pegvisomant.
authors.affiliation: Department of Internal Medicine, Edocrinology Unit, Erasums Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands. j.feenstra.1@erasmusmc.nl
authors.forename: J
authors.initials: J
authors.lastname: Feenstra
authors.forename: M O
authors.initials: MO
authors.lastname: van Aken
authors.forename: W W
authors.initials: WW
authors.lastname: de Herder
authors.forename: R A
authors.initials: RA
authors.lastname: Feelders
authors.forename: A J
authors.initials: AJ
authors.lastname: van der Lely
mesh_terms: D000172:Acromegaly / Q000150:complications / Q000188:drug therapy*; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D019382:Human Growth Hormone / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D019382:Human Growth Hormone; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C406545:pegvisomant; D015282:Octreotide