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

Abstract EN

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.