Table 3. Clinical, Biological, and Imaging Presentation of Cases With Acute Biliary Complications.
| Case 1 | Case 2 | Case 3 | Case 4 | |
|---|---|---|---|---|
| Age (years) | 68 | 66 | 68 | 44 |
| History of MD | Diabetes mellitus and hypertension | Diabetes mellitus | Diabetes mellitus and hypertension | None |
| BMI (kg/m2) | 25.3 | 23 | 30 | 24 |
| IGF-1 at diagnosis (ng/mL) | 795 | 774 | 672 | 1,500 |
| IGF-1 at the occurrence of AC (ng/mL) | 389.9 (ULN: 1.9) | 369 (ULN: 1.6) | 299 (ULN: 1.3) | 164 (NR) |
| Disease duration at the onset of the first symptoms (years) | 24 | 21 | 19 | 7 |
| The occurrence of cholelithiasis | After SA treatment | After SA treatment | Cholelithiasis at the diagnosis of acromegaly and before SA treatment | After SA treatment |
| AC-related symptoms | Sub jaundice, biliary colic | Atypical epigastralgia | Sub jaundice, biliary colic | Acute abdominal pain |
| Hepatic cytolysis | No | No | Yes | No |
| Biological cholestasis | TB: 24 mg/L; DB: 15 mg/L; GGT: 856 U/L | TB: 8 mg/L; DB: 3 mg/L; GGT: 36 U/L | TB: 117 mg/L; DB: 86 mg/L; GGT: 1,499 mg/L | TB: 35 mg/L; DB: 11 mg/L; GGT: 181 mg/L |
| Pancreatitis | No | No | No | No |
| Duration of treatment discontinuation before AC event | 2 years | 5 months | 5 months | Occurrence of AC during SA treatment |
| Abdominal US | Microlithiasis of the GB; dilation of CBD (16 mm) | Dilation of CBD (13 mm) | Dilation of the bile ducts (12 mm) | Cholecystitis associated with biliary peritonitis (confirmed on abdominal CT scan) |
| Biliary MRI | - | Not made because of a metal hip prosthesis | Dilation of bile duct (13 mm) | - |
| EUS | - | Dilation of CBD (12 mm) with sludge and microlithiasis; microlithiasis of the GB | Dilation of CBD (14 mm); microlithiasis of the GB | - |
| ERCP | Choledochal lithiasis (Fig. 4); dilation of CBD (20 mm); GS; endoscopic biliary drainage with stone extraction | Dilation of the bile ducts with lithiasis in CBD; endoscopic biliary drainage | Dilation of the bile ducts (17 mm); endoscopic biliary drainage | - |
AC: acute complication; BMI: body mass index; CBD: common bile duct; CT: computed tomography; DB: direct bilirubin; ERCP: endoscopic retrograde cholangiopancreatography; EUS: endoscopic ultrasonography; GB: gallbladder; GGT: gamma-glutamyl transferase; GS: gallstone; IGF-1: insulin-like growth factor 1; MD: metabolic disorder; MRI: magnetic resonance imaging; NR: normal range; SA: somatostatin analog; TB: total bilirubin; ULN: upper limit of normal; US: ultrasound.