Endocrine Abstracts

Introduction: Somatostatin analogues (SA) are the first-line treatment for Acromegaly in patients whose surgery failed to achieve cure or it was contraindicated. The main reported adverse events of SA are mild and transient, and include nausea, abdominal cramps, diarrhea and flatulence. Other side effects are of rare occurrence.

Case report: The authors describe a case of a 44-year-old previously asymptomatic male patient with a growth hormone-secreting pituitary macroadenoma partially involving the left cavernous sinus who was submitted to debulking transsphenoidal surgery. Biochemical and imaging remission were not accomplished and adjuvant treatment was initiated with lanreotide 120 mg every 8 weeks. Three days after the first administration, the patient attended the Emergency Department complaining of general abdominal pain, along with fever that resolved with paracetamol, nausea and acholia. He denied choluria, jaundice and alcohol intake. Physical examination revealed a slight right flank tenderness. Biochemical analysis exhibited high C-reactive protein (10.69 [0-0.5] mg/dl) and high serum pancreatic amylase (178 [13-53] U/l) and lipase (259 [13-60] U/l) levels. The remaining analytical investigation was unremarkable. A transabdominal ultrasonography showed no lithiasis, a non-dilated biliary tract and a normal gallbladder. Acalculous acute pancreatitis was assumed, but the patient refused hospitalization for proper treatment and investigation. Therefore, he was actively monitored in the outpatient setting. He got hydrated, progressively reintroduced the diet and avoided alcohol intake, with clinical improvement after one week. One month later, serum pancreatic amylase (145 [13-53] U/l) and lipase (245 [13-60] U/l) levels persisted high, but C-reactive protein level dropped (0.13 [0-0.5] mg/dl) and transabdominal ultrasound remained unremarkable. Two months after the episode, C-reactive protein (0.05 [0-0.5] mg/dl) level persisted low, and serum pancreatic amylase (67 [13-53] U/l) and lipase (102 [13-53] U/l) levels dropped near to the upper normal limit, with no clinical relapse. Acalculous acute pancreatitis was assumed, and lanreotide was presumed as the culprit.

Conclusions: As far as the authors know, the association between acalculous acute pancreatitis and a SA was only reported once in the literature. This may be due to spasm of the sphincter of Oddi with subsequent biliary-pancreatic obstruction. This case report highlights the need to raise awareness on SA-induced acute pancreatitis and include it in the differential diagnosis of a patient who present abdominal complaints after initiating a treatment with a SA.