Endocrine Abstracts

Background: World Gastroenterology Organisation (WGO) quotes gallstones prevalence of 9-21%, incidence of 0.63/100 persons/year in Europe; 10-15% of UK population have gallstones (1). Acromegaly patients’ prevalence is 8.3% and 35% developing incidental gallstones during somatostatin analogue (SSA) treatment (2).

Objective: To evaluate the prevalence of gallstones in SSA treated Acromegaly patients in University Hospitals of Leicester (UHL).

Methods: Retrospective case notes and electronic records’ review of consecutive Acromegaly patients in UHL from 1957 to 2021 (UHL audit No 9300).

Results: N = 132 Acromegaly patients, 45/132 (35%) received SSA, male 30/45 (66%), female 15/45 (33%). Octreotide 22/45 (49%), Lanreotide 15/45 (33%), 8/45 (18%) received both. Of the 45 in SSA group, the gallstone prevalence is 6/45 (13%), 5/6 (83%) female. 30/45 (66%) SSA group had BMI of ≥25, 6/6 (100%) who had gallstones had BMI ≥25; 2/6 (33%) underwent cholecystectomy. 4/6 (66%) continued treatment, 2/6 (33%) SSA stopped due to Acromegaly remission. Mean duration of SSA: 45 SSA patients - 7.25 years; 6 gallstone patients on SSA 13 years. Of the 87 non-SSA group 5/87 (6%) had incidental gallstones, 4/5 (80%) female.

Discussion: Cholelithiasis is a recognized side effect of SSA. Possible mechanisms of SSA-induced cholelithiasis: a) delayed gallbladder emptying through inhibition of cholecystokinin release b) alteration of hepatic bile composition resulting in gallbladder stasis. Electronic Medicines Compendium (EMC) recommends ultrasound surveillance at baseline and at 6-12 monthly intervals. Our audit showed the cholelithiasis prevalence to be similar to that of background population and correlates to weight and female gender. Limitations are small number, retrospective study’s inherent limitations and absent of baseline ultrasound.

Conclusion: 1. The prevalence of gallstones in the SSA treated cohort remains similar to that of background population.

2. Routine surveillance scan for gallstones in SSA treated Acromegaly patients may not be necessary unless symptomatic.