Risk factors for cholelithiasis in patients with acromegaly:
(1) acromegaly itself, possible due to endogenous hormone secretion (Montini et al, page 405).
(2) continuous octreotide therapy (which results in significant decrease in gallbladder motility)
(3) chronic hemolysis (sickle cell anemia, other)
Gender, age, obesity and family history of cholelithiasis are not risk factors for gallstones in patients with acromegaly as opposed to the general population.
Reducing the risk:
(1) If on octreotide, having a drug-free period each week (which results in transient gallbladder hypermotility)
(2) Consider therapy with ursodeoxycholic acid. This may not help if the person has chronic hemolysis contributing to the stone formation.
Discontinuation of octreotide therapy should be done with caution if the patient has evidence of significant debris in the gallbladder, since forcible ejection may precipitate biliary colic or pancreatitis.
