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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....
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi Publishing Corporation
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763006/ https://www.ncbi.nlm.nih.gov/pubmed/26977326 http://dx.doi.org/10.1155/2016/2087102 |
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author | Mallea-Gil, Maria Susana Bernabeu, Ignacio Spiraquis, Adriana Avangina, Alejandra Loidi, Lourdes Ballarino, Carolina |
author_facet | Mallea-Gil, Maria Susana Bernabeu, Ignacio Spiraquis, Adriana Avangina, Alejandra Loidi, Lourdes Ballarino, Carolina |
author_sort | Mallea-Gil, Maria Susana |
collection | PubMed |
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 | Online Article Text |
id | pubmed-4763006 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Hindawi Publishing Corporation |
record_format | MEDLINE/PubMed |
spelling | pubmed-47630062016-03-14 Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 (⁎) 28 Mutation Mallea-Gil, Maria Susana Bernabeu, Ignacio Spiraquis, Adriana Avangina, Alejandra Loidi, Lourdes Ballarino, Carolina Case Rep Endocrinol Case Report 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. Hindawi Publishing Corporation 2016 2016-02-09 /pmc/articles/PMC4763006/ /pubmed/26977326 http://dx.doi.org/10.1155/2016/2087102 Text en Copyright © 2016 Maria Susana Mallea-Gil et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Mallea-Gil, Maria Susana Bernabeu, Ignacio Spiraquis, Adriana Avangina, Alejandra Loidi, Lourdes Ballarino, Carolina Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 (⁎) 28 Mutation |
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 |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763006/ https://www.ncbi.nlm.nih.gov/pubmed/26977326 http://dx.doi.org/10.1155/2016/2087102 |
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