Pegvisomant
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First report of lipohypertrophy: 2 case reports A 35-year-old man and a 38-year-old woman developed focal lipohypertrophy during treatment with pegvisomant for acromegaly. Both patients started SC pegvisomant 10 mg/day (1mL), and rotated the injection site around the umbilical area. They started to report marked abdominal distention unrelated to bowel or abdominal abnormalities after 1 month. Their abdominal distension was clearly visible on examination after the second month of therapy; it was soft, homogeneous and associated with marked thickening of subcutaneous tissues. The man’s insulin-like growth factor-I (IGF-I) level was 750 µg/L at month 2, compared with 1432 µg/L at baseline, and his waist circumference was 99cm at month 2 compared with 96cm at baseline. The corresponding values for the woman were 721 µg/L and 1329 µg/L, respectively, and 94cm and 87cm, respectively. A focal accumulation of adipose tissue without increased visceral fat depots was confirmed by abdominal ultrasonography and MRI. [Treatment and patient outcomes not stated.] Author comment: "[P]egvisomant may be able to induce subcutaneous lipohypertrophy at the abdominal site by growth hormone inhibition or by unknown direct mechanisms when injected in the same area for a prolonged time. The IGF-I values in our 2 patients suggest that transient growth hormone deficiency may have been a cause of focal hypertrophy." Maffei P, et al. Lipohypertrophy in acromegaly induced by the new growth hormone receptor antagonist pegvisomant. Annals of Internal Medicine 145: 801049416 310-312, No. 4, 15 Aug 2006 - Italy
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of lipohypertrophy associated with pegvisomant. The WHO Adverse Reactions Database did not contain any reports of obesity associated with pegvisomant.
0114-9954/10/1126-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 4 Nov 2006 No. 1126
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