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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.

case reports in endocrinology

Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mo> </mml:mo><mml:msup><mml:mrow><mml:mi>​</mml:mi></mml:mrow><mml:mrow><mml:mi mathvariant="normal"></mml:mi><mml:mo mathvariant="bold">⁎</mml:mo><mml:mi mathvariant="normal"></mml:mi></mml:mrow></mml:msup><mml:mo> </mml:mo></mml:math>28 Mutation

Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ​⁎ 28 Mutation

Pegvisomant-Induced Cholestatic Hepatitis in an Acromegalic Patient with UGT1A1 ⁎ 28 Mutation