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Pegvisomant-Induced Lipohypertrophy: Report of a Case with Histopathology

Monica Marazuela, MD, PhD; Esteban Daudén, MD, PhD; Elena Ocón, MD; Dolores Moure, MD; and Lia Nattero, MD
[+] Article, Author, and Disclosure Information

From Hospital de la Princesa, Universidad Autónoma, Madrid 28006, Spain.

Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2007;147(10):741-743. doi:10.7326/0003-4819-147-10-200711200-00019
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Figure 1.
Variations in insulin-like growth factor I (IGF-I) and growth hormone concentrations in response to treatment with somatostatin (SS) analogues and to different doses of pegvisomant (PEG).

The dashed lines span the normal range of IGF-I levels. After rotating the site of injection, IGF-I levels decreased to within the normal range and the pegvisomant dose could be reduced (arrow).

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Figure 2.
Photographs of both arms.

Left. The left arm showed an enlargement where pegvisomant was injected. Middle. The right arm was not affected. Right. The left arm 1 month after withdrawal of pegvisomant injection therapy.

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Figure 3.
Ultrasonogram of the left arm, showing subcutaneous fat tissue accumulation.
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Figure 4.
Biopsy specimens of the enlarged left arm.

Top. Normal subcutaneous tissue, with groups of adipocytes in the reticular dermis (hematoxylin–eosin stain; original magnification, ×40). Bottom. Mature adipocytes appeared normal, with no inflammatory cells and no fat necrosis (hematoxylin–eosin stain; original magnification, ×400).

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