Related Experiment Videos
Hepatolithiasis (intrahepatic stone) during octreotide therapy for acromegaly: a case report
1Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
Insights
This case study highlights the first instance of intrahepatic stones (hepatolithiasis) developing during octreotide treatment for acromegaly. Octreotide may increase the risk of bile duct stones, especially in predisposed patients.
Area of Science:
- Hepatology
- Endocrinology
- Gastroenterology
Background:
- Acromegaly is a condition caused by excess growth hormone, often treated with somatostatin analogs like octreotide.
- Hepatolithiasis, or intrahepatic stones, is rare in Western countries but common in East Asia, often linked to bile stasis.
- Octreotide is known to cause gallbladder stasis and sludge, but intrahepatic stone formation is not well-documented.
Observation:
- A 37-year-old male with acromegaly, treated with octreotide, developed hepatolithiasis complicated by gram-negative sepsis.
- The patient had a prior history of liver trauma and surgery in childhood.
- This represents the first reported case of hepatolithiasis occurring during octreotide therapy.
Findings:
- Octreotide therapy may contribute to the formation of intrahepatic stones, beyond its known effects on the gallbladder.
- Altered bile acid composition due to octreotide could accelerate intrahepatic sludge and stone development.
- The patient's history of liver injury may have predisposed him to bile stasis.
Implications:
- Clinicians should exercise increased caution when prescribing octreotide or its long-acting analogs to patients with risk factors for intrahepatic bile stasis.
- Further research is warranted to elucidate the mechanisms by which octreotide may influence intrahepatic stone formation.
- This case underscores the importance of monitoring for biliary complications in patients on long-term octreotide therapy, particularly those with pre-existing biliary conditions.
Abstract:
We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis during octreotide therapy. Gallstones and bile sludge are common side effects of octreotide therapy but rarely become symptomatic or require treatment. Hepatolithiasis is uncommon in western countries but is quite prevalent in East Asia and is often associated with a predisposing condition that causes intrahepatic bile stasis (eg. bile duct stricture). In addition to its known effect on gallbladder stasis, octreotide alters bile acid composition and may thus hasten intrahepatic sludge and stone formation. Extra caution should be taken in using octreotide or its long-acting analog in patients otherwise predisposed to intrahepatic bile stasis.