Adverse events associated with somatostatin analogs in acromegaly

Grasso, Ludovica F. S.; Auriemma, Renata S.; Pivonello, Rosario; Colao, Annamaria

doi:10.1517/14740338.2015.1059817

Cited by 41 publications

(41 citation statements)

References 104 publications

(140 reference statements)

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“…Other retrospective studies based on patients with NENs reported a prevalence of 52%–63%, but studies on this specific population are few . On the contrary, many studies on patients receiving SSAs to treat acromegaly are available, reporting a very variable biliary stone frequency (3%–56% in the first 2 years of treatment) . However, patients with acromegaly are not comparable to those with NETs, because acromegaly has already been identified as a risk factor for gallstones occurrence per se .…”

Section: Discussionmentioning

confidence: 99%

“…The role of SSAs in the pathogenesis of gallstone disease is related to several factors. First, SSAs tend to inhibit meal‐stimulated cholecystokinin release, resulting in reduced gallbladder motility . In addition, SSAs slow intestinal transit, allowing intestinal bacteria to increase the amounts of deoxycholate, which favors the aggregation of cholesterol crystals into stones.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported an increased gallstone incidence in patients receiving SSAs if compared with the general population, although with very variable data; however, most of these studies have been conducted among patients with acromegaly . In fact, only few studies are specifically focused in patients with NETs, and all are retrospective in nature; the observed incidence of biliary stone disease in this specific population ranges from 36% to 63% .…”

Section: Introductionmentioning

confidence: 99%

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Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study

et al. 2019

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Background Somatostatin analogs (SSAs) are the mainstay of neuroendocrine tumor (NET) treatment. Biliary stone disease is reported as a common side effect of SSAs, with a frequency ranging from 10% to 63%. Studies on SSA‐treated patients for acromegaly report an increased incidence of biliary stone disease compared with the general population, whereas data on patients with NETs are few. Guidelines are based on weak evidence, thus resulting in conflicting recommendations. The aim of the study is to evaluate biliary stone disease incidence, complications, and risk factors in a large population of SSA‐treated patients with NETs. Materials and Methods A retrospective analysis of a prospectively collected database was performed. Patients with a diagnosis of NET in seven dedicated centers from 1995 to 2017 were included at the time of SSA start. Results A total of 754 SSA‐treated patients were evaluated. Patients with history of cholecystectomy or with known biliary stone disease were excluded; 478 patients were included. Among them, 118 patients (24.7%) received prophylactic ursodeoxycholic acid (UDCA). During the study period, 129 patients (27.0%) developed biliary stone disease; of them, 36 (27.9%) developed biliary complications. On multivariate analysis, primary gastrointestinal (GI)‐NET (hazard ratio [HR] 1.76) and related surgery (HR 1.58) were independent risk factors for biliary stone disease. Conclusion We report a high incidence of biliary stone disease particularly in GI‐NET or GI surgery. UDCA prophylaxis does not seem to have a protective role. Our data suggest that all patients with primary GI‐NET or undergoing abdominal surgery should be considered for prophylactic cholecystectomy; no conclusion could be drawn on the indication of prophylactic cholecystectomy in patients with primary pancreatic or thoracic NET for whom abdominal surgery is not planned. Implications for Practice The results of this study confirm an increased rate of gallstones development and related complications in patients with neuroendocrine tumors (NETs) treated with somatostatin analogs (SSAs). NETs of the gastrointestinal (GI) tract and related surgery are independent risk factors for biliary stone disease development. Therefore, all patients with primary GI‐NET or undergoing abdominal surgery should be considered for prophylactic cholecystectomy. Data on other subgroups are not exhaustive, and management also evaluating additional clinical features (life expectancy, surgical and anesthesiological risks) should be considered. Prophylactic treatment with ursodeoxycholic acid does not seem to be a protective factor for SSA‐related biliary stone disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study

et al. 2019

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“…Cholelithiasis represents the most serious complication of SSAs, but is generally asymptomatic, and has been reported in 3-56% of patients. Pasireotide has shown a safety profile as expected for an SSA, except for the degree of hyperglycemia [189]. Uncommon side effects include sinus bradycardia, asthenia, headache, pruritus, decreased libido, increased serum bilirubin, and constipation [190].…”

Section: Adverse Eventsmentioning

confidence: 97%

Somatostatin Analogs in Clinical Practice: A Review

Gomes-Porras

Cárdenas-Salas

Álvarez-Escolá

2020

IJMS

164

136

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Somatostatin analogs are an invaluable therapeutic option in the diagnosis and treatment of somatotropinomas, thyrotropinomas, and functioning and non-functioning gastroenteropancreatic neuroendocrine tumors. They should also be considered an effective and safe therapeutic alternative to corticotropinomas, gonadotropinomas, and prolactinomas resistant to dopamine agonists. Somatostatin analogs have also shown to be useful in the treatment of other endocrine diseases (congenital hyperinsulinism, Graves' orbitopathy, diabetic retinopathy, diabetic macular edema), non-endocrine tumors (breast, colon, prostate, lung, and hepatocellular), and digestive diseases (chronic refractory diarrhea, hepatorenal polycystosis, gastrointestinal hemorrhage, dumping syndrome, and intestinal fistula).

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“…LA-SSAs suppress GH secretion by preferential binding to somatostatin receptor subtype 2a (SSTR2a). LA-SSAs have favorable safety profiles and a clinically neutral impact on glucose homeostasis (4,5). In clinical practice only about 40% of patients treated with monotherapy LA-SSAs achieve biochemical normalization of GH and IGF-I.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of switching to pasireotide in acromegaly patients controlled with pegvisomant and somatostatin analogues: PAPE extension study

Muhammad¹,

Coopmans²,

Delhanty³

et al. 2018

European Journal of Endocrinology

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Adverse events associated with somatostatin analogs in acromegaly

Abstract: On the basis of these findings, a close and careful monitoring of gallbladder ultrasound and glucose levels is recommended in patients receiving SSA for medical treatment of acromegaly.

Cited by 41 publications

References 104 publications

Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study

Biliary Stone Disease in Patients with Neuroendocrine Tumors Treated with Somatostatin Analogs: A Multicenter Study

Somatostatin Analogs in Clinical Practice: A Review

Efficacy and safety of switching to pasireotide in acromegaly patients controlled with pegvisomant and somatostatin analogues: PAPE extension study

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