THE IMPACT OF CONTINUOUS SUBCUTANEOUS INFUSION OF OCTREOTIDE ON GALLSTONE FORMATION IN ACROMEGALIC PATIENTS

Treatment of acromegaly with intermittent sc injections of octreotide is associated with an increased incidence of cholelithiasis. We invest igated the incidence of gallstone formation, the occurrence of gallbla dder disease, and the response of gallstones to ursodeoxycholic acid i n 30 acromegalic patients who were treated with a continuous sc infusi on of octreotide at doses between 200 and 800 mu g/day for 3-70 months . Of the 30 patients, 28 had pretreatment ultrasonography of the bilia ry tree performed, and all had frequent follow-ups, Nine patients unde rwent pre- and posttreatment bile sampling. No patient treated for les s than 6 months and 18.5% of patients treated for more than 6 months d eveloped new gallstones. No patient developed symptomatic cholelithias is while receiving octreotide therapy. Of six patients who developed g allstones, four were treated with ursodeoxycholic acid, which dissolve d all gallstones. One patient with gallstones experienced an episode o f biliary colic when octreotide was withdrawn; however, no cholecystit is was found at subsequent cholecystectomy. Bile sampling showed that 8 (75%) of the 12 patients who were assessed demonstrated microcrystal s, whereas in 3 (50%) of 6 patients who were closely analyzed thereaft er, microcrystals disappeared once octreotide therapy was stopped. Our results show that continuous sc infusion octreotide therapy increases the incidence of cholelithiasis over normal values, as is the case wi th intermittent sc injections. Although higher octreotide levels are s ustained with continuous sc infusion, this is not associated with an i ncreased risk of gallstone formation compared with intermittent sc oct reotide therapy.