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


METHODS
Retrospective survey on hospital records in acromegalic patients followed up in the last 20 yr in tertiary referral centers.


METHODS
Four hundred and fifty-nine patients (272 females).


METHODS
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 17.6%, 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.
Endocrinology, Ospedali Riuniti, Bergamo, Italy. roberto.serena@libero.it
R
R
Attanasio
A
A
Mainolfi
F
F
Grimaldi
R
R
Cozzi
M
M
Montini
C
C
Carzaniga
S
S
Grottoli
L
L
Cortesi
M
M
Albizzi
R M
RM
Testa
L
L
Fatti
D
D
De Giorgio
C
C
Scaroni
F
F
Cavagnini
P
P
Loli
G
G
Pagani
E
E
Ghigo
D000172:Acromegaly / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D015331:Cohort Studies; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000139:chemically induced* / Q000453:epidemiology; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013004:Somatostatin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D019382:Human Growth Hormone; D013004:Somatostatin