Background and aims: We have previously reported an increased prevalence of gallbladder polyps in treatment-naive acromegaly when compared with the general population (29 vs 4.6%), with potential implications for future malignant transformation and screening. However, little is known about biochemical markers of liver function in active acromegaly, or in response to treatment. Furthermore, somatostatin analogue (SSA) therapy is associated with the development of gallstones. Here, we examine biliary ultrasound findings and biochemical liver function before and after SSA treatment in newly-diagnosed acromegaly.
Method: Biliary ultrasound findings and biochemical liver status was assessed in 39 newly diagnosed, treatment naïve patients with acromegaly, at baseline and after six months of SSA therapy.
Results: Somatostatin analogue treatment was effective in reducing GH and IGF-1 levels (mean changes: GH, 13.92 μg/l, P<0.03; IGF-1, 1.83× upper limit of normal, P<0.00001). Biochemical markers of liver function (ALT, ALP, bilirubin, albumin) were within reference ranges at baseline, with no significant effect after 6 months of SSA therapy. Thirteen of thirty-nine (33%) patients had gallbladder polyps at baseline. Interestingly, only 7 of the 39 (18%) still had visible polyps after SSA. Gallstones (3/39 pre- and 8/39 post-SSA) and gallbladder sludge/debris (0/39 pre-and 6/39 post-SSA) both increased after 6 months of medical treatment.
Conclusions: Within the limitations of sample size and follow-up duration, our results confirm a high prevalence of gallbladder polyps in de novo acromegaly, and an increased risk of gallstones and gallbladder sludge/debris following SSA treatment. We saw no significant effect of acromegaly or SSA treatment on biochemical liver function. The finding that SSA therapy was associated with an apparent reduction in the prevalence of gallbladder polyps is interesting, and provides further suggestion that this should be considered a potential consequence of uncontrolled acromegaly, to be taken into consideration in screening for comorbidities.
07 Nov 2016 - 09 Nov 2016