Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation
Pegvisomant (PEGv) is a growth hormone receptor antagonist approved for the treatment of acromegaly; one of its documented adverse effects is reversible elevation of hepatic enzymes. We report a 39-year-old male acromegalic patient with a pituitary macroadenoma who underwent transsphenoidal surgery....
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2016/2087102 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850232385419870208 |
|---|---|
| author | Maria Susana Mallea-Gil Ignacio Bernabeu Adriana Spiraquis Alejandra Avangina Lourdes Loidi Carolina Ballarino |
| author_facet | Maria Susana Mallea-Gil Ignacio Bernabeu Adriana Spiraquis Alejandra Avangina Lourdes Loidi Carolina Ballarino |
| author_sort | Maria Susana Mallea-Gil |
| collection | DOAJ |
| description | Pegvisomant (PEGv) is a growth hormone receptor antagonist approved for the treatment of acromegaly; one of its documented adverse effects is reversible elevation of hepatic enzymes. We report a 39-year-old male acromegalic patient with a pituitary macroadenoma who underwent transsphenoidal surgery. The patient’s condition improved but GH and IGF-I levels did not normalize; as a consequence, we first administered dopamine agonists and then somatostatin receptor ligands (SRLs) with poor response. PEGv 15 mg every other day was added to lanreotide 120 mg monthly. The patient developed a severe hepatitis five months after starting the combination therapy. Elevated ferritin, iron, and transferrin saturation suggested probable hepatitis due to haemochromatosis. We performed a liver biopsy which showed an acute cholestatic hepatitis consistent with toxic etiology. A heterozygous genotype UGT1A1⁎28 polymorphism associated with Gilbert’s syndrome was also found in this Argentine patient. The predominant clinical presentation resembled an acute cholestatic hepatitis associated with severe hemosiderosis, a different and new pattern of PEGv hepatotoxicity. |
| format | Article |
| id | doaj-art-0077c11b4c2f47179bbf11ad7ee7a456 |
| institution | OA Journals |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-0077c11b4c2f47179bbf11ad7ee7a4562025-08-20T02:03:13ZengWileyCase Reports in Endocrinology2090-65012090-651X2016-01-01201610.1155/2016/20871022087102Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 MutationMaria Susana Mallea-Gil0Ignacio Bernabeu1Adriana Spiraquis2Alejandra Avangina3Lourdes Loidi4Carolina Ballarino5Servicio de Endocrinologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, ArgentinaEndocrinology Division and Fundacion Publica Galega de Medicina Xenomica (Unidad de Medicina Molecular), Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Travesia Choupana s/n, Santiago de Compostela, 15706 La Coruña, SpainServicio de Gastroenterologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, ArgentinaDepartamento de Anatomıa Patologica, Hospital de Clínicas, Universidad de Buenos Aires, 2351 Córdoba Avenue, 1120 Buenos Aires, ArgentinaEndocrinology Division and Fundacion Publica Galega de Medicina Xenomica (Unidad de Medicina Molecular), Complejo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Travesia Choupana s/n, Santiago de Compostela, 15706 La Coruña, SpainServicio de Endocrinologıa, Hospital Militar Central, 726 Luis María Campos Avenue, 1425 Buenos Aires, ArgentinaPegvisomant (PEGv) is a growth hormone receptor antagonist approved for the treatment of acromegaly; one of its documented adverse effects is reversible elevation of hepatic enzymes. We report a 39-year-old male acromegalic patient with a pituitary macroadenoma who underwent transsphenoidal surgery. The patient’s condition improved but GH and IGF-I levels did not normalize; as a consequence, we first administered dopamine agonists and then somatostatin receptor ligands (SRLs) with poor response. PEGv 15 mg every other day was added to lanreotide 120 mg monthly. The patient developed a severe hepatitis five months after starting the combination therapy. Elevated ferritin, iron, and transferrin saturation suggested probable hepatitis due to haemochromatosis. We performed a liver biopsy which showed an acute cholestatic hepatitis consistent with toxic etiology. A heterozygous genotype UGT1A1⁎28 polymorphism associated with Gilbert’s syndrome was also found in this Argentine patient. The predominant clinical presentation resembled an acute cholestatic hepatitis associated with severe hemosiderosis, a different and new pattern of PEGv hepatotoxicity.http://dx.doi.org/10.1155/2016/2087102 |
| spellingShingle | Maria Susana Mallea-Gil Ignacio Bernabeu Adriana Spiraquis Alejandra Avangina Lourdes Loidi Carolina Ballarino Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation Case Reports in Endocrinology |
| title | Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation |
| title_full | Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation |
| title_fullStr | Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation |
| title_full_unstemmed | Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation |
| title_short | Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation |
| title_sort | pegvisomant induced cholestatic hepatitis in an acromegalic patient with ugt1a1 28 mutation |
| url | http://dx.doi.org/10.1155/2016/2087102 |
| work_keys_str_mv | AT mariasusanamalleagil pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation AT ignaciobernabeu pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation AT adrianaspiraquis pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation AT alejandraavangina pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation AT lourdesloidi pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation AT carolinaballarino pegvisomantinducedcholestatichepatitisinanacromegalicpatientwithugt1a128mutation |