Endocrine Abstracts

Background

Somatostatin receptor ligands (SRL) are commonly used in patients with acromegaly to control insulin growth factor 1 (IGF1) concentrations. Biliary sludge or gallstone formation are well-recognised biliary adverse events (BAE) from SRL therapy. Our current practice is to routinely monitor patients with acromegaly on SRL with ultrasound scanning (USS). Once BAE are detected, ursodeoxycholic acid (UDCA) therapy is initiated.

Objectives

This single centre retrospective study aimed to evaluate: 1) cholecystectomy rates in our cohort; 2) incidence of BAE and; 3) efficacy of UDCA therapy.

Methods

All patients with acromegaly treated with SRL at our centre were included. For those on pegvisomant therapy data were collected during previous SRL treatment only. Exclusion criteria were known cholelithiasis or cholecystectomy predating SRL therapy and absence of ultrasound surveillance. The following data were recorded: age at diagnosis, gender, baseline IGF1, baseline and follow-up USS findings, UDCA dose and duration of USS follow-up.

Results

Out of 57 eligible patients, 1 had pre-existing cholelithiasis, USS surveillance was absent in 6 patients and 9 individuals had only baseline USS data available. For the remaining 41 patients with complete dataset, mean age at diagnosis was 46 years, 60% were females and mean baseline IGF1 was 105 nmol/L. Median duration of follow up was 6 years (interquartile range 6). Cholecystectomy was performed in 4/56 patients (7.1%) for BAE; 3/4 required emergency admission for pancreatitis, cholecystitis and/or cholangitis. Moreover, 25/41 (61%) patients developed BAE (13 with gallstones and 12 with sludge) during follow-up. 22 patients were treated with UDCA with a median daily dose of 350mg (interquartile range 300-600mg). In 16/22 (73%) patients (7 with gallstone and 9 with sludge) a complete response was observed on follow-up USS.

Conclusion

BAE occured frequently in our cohort of patients with acromegaly on SRL. The use of UDCA therapy is highly efficacious at dissolving sludge and gallstones once detected on USS monitoring. Further studies are needed to establish whether low-dose UDCA prophylaxis may be useful to prevent BAE in patients on SRL therapy.