DESIGN: Forty-nine patients (23 men and 26 women, aged 19-81 years) were studied by repeated gall-bladder ultrasonography performed at baseline and then every 6 months during
octreotide therapy. All ultrasound scans were evaluated by the same radiologist. Statistical analysis was performed using the Chi-squared and regression analysis tests.
RESULTS: Asymptomatic stones were recorded in 13/49 patients (26.5%) prior to
octreotide treatment (the prevalence of
cholelithiasis in the Italian population is 9.5% in men and 18.9% in women). During
octreotide therapy gallstones developed in 10/36 patients (27.7%). No significant correlations with sex, age, body mass index, duration of the disease, daily dose and duration of
octreotide therapy, altered gall-bladder form, family history of gallbladder stones, basal plasma values of
cholesterol and
triglycerides were found between the patients (10/36) who developed stones during
octreotide treatment and the ones who did not (26/36). Fourteen patients (10 with newly developed stones and four with
cholelithiasis diagnosed prior to
octreotide) were put on
ursodeoxycholic acid at the daily dose of 10 mg/kg.
Gallstones completely disappeared in 6/14 patients (42.8%; five patients with newly developed stones and one with stones prior to
octreotide therapy) after a mean of 30.8 months of
ursodeoxycholic acid treatment. In addition, seven patients were treated with
ursodeoxycholic acid at the preventive dose of 450 mg, administered as a once-a-day oral preparation in the evening. However, stones developed in one of these seven patients who was thereafter cured (
gallstones completely disappeared) by the therapeutic dose of
ursodeoxycholic acid of 10 mg/kg/day after 23 months of treatment.
CONCLUSIONS: This study indicates that (i)
acromegaly by itself is correlated with a high prevalence of gallbladder stones, (ii) the long-term treatment with
octreotide increases the incidence of
cholelithiasis, and (iii)
ursodeoxycholic acid is useful in the treatment of
gallstones in acromegalic patients but its prophylactic effect in patients on
octreotide treatment requires further assessment.