Adverse hepato-biliary-pancreatic events in acromegaly patients treated with first generation somatostatin receptor ligands

First-generation somatostatin receptor ligands (SRLs) are first-line medical therapy for acromegaly. During long-term treatment, hepato-biliary-pancreatic adverse events can occur. This study aimed to evaluate the prevalence and predictors of hepato-biliary-pancreatic adverse events during SRL-treatment. In this multicenter study, data of 371 acromegaly patients (223 females) were retrospectively collected at the start of SRL therapy (T0), and at the last follow-up visit (120 ± 97.31 months). The occurrence of hepato-biliary-pancreatic adverse events and their relationship with features at T0 were investigated. Sixty-one patients (16.4%) underwent cholecystectomy (CH-Tx), cholecystitis (CH) occurred in 3.8%, severe or mild hyperlipasemia/hyperamylasemia in 2.2% and in 5.1%, severe or mild hypertransaminasemia in 1.1% and in 6.4%,respectively. No significant differences emerged after patient stratification by gender or age (≤/>50yrs). BMI, GH and IGF1 values were not associated with a higher risk of biliary complications. Patients undergoing CH-Tx or CH had a higher prevalence of cholelithiasis at T0 (p = 0.002 and p = 0.005). Cholelithiasis (p = 0.040) and biliary sludge (p = 0.014) at T0 were independent predictors of cholecystectomy. Cholelithiasis also strongly predicted cholecystitis in both univariable (p = 0.012) and multivariable (p = 0.025) analyses. Ursodeoxycholic acid (UDCA) treatment was associated with cholecystitis (p = 0.007) and mild-hypertransaminasemia (p = 0.035). When considering overall hepato-biliary-pancreatic adverse events, cholelithiasis, biliary sludge and age at T0 were significant predictors in both univariate (p = 0.006,p = 0.010,p = 0.013) and multivariable analysis (p = 0.029,p = 0.028,p = 0.044). Hepato-biliary-pancreatic adverse events are not infrequent during long-term SRLs therapy and are influenced overall by older age, cholelithiasis and biliary sludge.