title: Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 (⁎) 28 Mutation.
abstract: Pegvisomant (PEGv) is a growth hormone receptor antagonist approved for the treatment of acromegaly; one of its documented adverse effects is reversible elevation of hepatic enzymes. We report a 39-year-old male acromegalic patient with a pituitary macroadenoma who underwent transsphenoidal surgery. The patient's condition improved but GH and IGF-I levels did not normalize; as a consequence, we first administered dopamine agonists and then somatostatin receptor ligands (SRLs) with poor response. PEGv 15 mg every other day was added to lanreotide 120 mg monthly. The patient developed a severe hepatitis five months after starting the combination therapy. Elevated ferritin, iron, and transferrin saturation suggested probable hepatitis due to haemochromatosis. We performed a liver biopsy which showed an acute cholestatic hepatitis consistent with toxic etiology. A heterozygous genotype UGT1A1 (⁎) 28 polymorphism associated with Gilbert's syndrome was also found in this Argentine patient. The predominant clinical presentation resembled an acute cholestatic hepatitis associated with severe hemosiderosis, a different and new pattern of PEGv hepatotoxicity.
authors.affiliation: Servicio de Endocrinologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, Argentina.
authors.forename: Maria Susana
authors.initials: MS
authors.lastname: Mallea-Gil
authors.affiliation: Endocrinology Division and Fundacion Publica Galega de Medicina Xenomica (Unidad de Medicina Molecular), Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Travesia Choupana s/n, Santiago de Compostela, 15706 La Coruña, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bernabeu
authors.affiliation: Servicio de Gastroenterologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, Argentina.
authors.forename: Adriana
authors.initials: A
authors.lastname: Spiraquis
authors.affiliation: Departamento de Anatomıa Patologica, Hospital de Clínicas, Universidad de Buenos Aires, 2351 Córdoba Avenue, 1120 Buenos Aires, Argentina.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Avangina
authors.affiliation: Endocrinology Division and Fundacion Publica Galega de Medicina Xenomica (Unidad de Medicina Molecular), Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Travesia Choupana s/n, Santiago de Compostela, 15706 La Coruña, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Loidi
authors.affiliation: Servicio de Endocrinologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, Argentina.
authors.forename: Carolina
authors.initials: C
authors.lastname: Ballarino