Clinical Features of Hepatic Cirrhosis in Hypopituitarism

Abstract

Background Hepatic cirrhosis represents the final stage for a wide variety of chronic liver diseases, which may be induced by numerous causes, and is associated with high mortality when complications arise. The relationships between hormone deficiencies due to hypopituitarism and hepatic cirrhosis have been rarely reported. Objective To analyze the clinical characteristics of 8 cases of hepatic cirrhosis secondary to hypopituitarism, and investigate the potential role of hypopituitarism in the development of hepatic cirrhosis. Methods Participants were 8 patients with hepatic cirrhosis secondary to hypopituitarism who were recruited from the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2021. A retrospective analysis was conducted on their clinical manifestations, laboratory and imaging test result, treatments and follow-up results. Results The age at the diagnosis of hypopituitarism for all cases ranged from 9 to 20 years old, and that at the diagnosis of hepatic cirrhosis was 16 to 24 years old, with an interval of 3 to 14 years old. The causes of hypopituitarism were germ cell tumor surgery (4 cases), craniopharyngioma surgery (2 cases), radiotherapy for nasopharyngeal carcinoma (1 case) and pituitary stalk interruption syndrome (1 case). All cases received no standardized hormone replacement therapy before cirrhosis was diagnosed by biopsy (2 cases) or imaging (6 cases). Fatigue, anorexia, hypoplastic external genitalia, short stature, recurrent upper respiratory tract infection and bleeding were the most common clinical manifestations. All cases had abnormalities in pituitary-thyroid axis, pituitary-gonadal axis, growth hormone, insulin-like growth factor-1, routine blood markers, four markers of hepatic fibrosis and liver imaging results. Moreover, it was found that 7 cases were also with abnormalities in antidiuretic hormone and hepatic function, and 6 cases were with abnormalities in pituitary-adrenal axis, coagulation function and serum lipids. All patients received treatment with desmopress in acetate, thyroid hormone, hydrocortisone and sex hormones as necessary. Four patients also received growth hormone replacement therapy. One-year follow-up indicated that, all cases had significantly improved levels of leukocyte, platelet, aspartate aminotransferase, alkaline phosphatase, total bilirubin, indirect bilirubin, total cholesterol, low-density lipoprotein, high-density lipoprotein, fibrinogen and four markers of hepatic fibrosis after treatment (P<0.05). However, no significant post-treatment improvement was found in the levels of hemoglobin, alanine aminotransferase, gamma-glutamyl transpeptidase, direct bilirubin, triacylglycerol and D-dimer, and in prothrombin time and endogenous prothrombin potential (P>0.05) . Conclusion All these 8 patients with hypopituitarism had hormone deficiency for several years before the diagnosis of hepatic cirrhosis, and abnormalities in thyroid hormone, sex hormone, growth hormone, insulin-like growth factor-1, routine blood markers, four markers of hepatic fibrosis and imaging results, with fatigue, anorexia, hypoplastic external genitalia, short stature, recurrent upper respiratory tract infection and bleeding as the most common clinical manifestations. One-year standardized hormone replacement therapy significantly improved the abnormalities in leukocyte, platelets, total cholesterol, high-density lipoprotein, low-density lipoprotein, fibrinogen and four markers of hepatic fibrosis.

Keywords

• hypopituitarism|liver cirrhosis|non-alcoholic fatty liver disease|hormone replacement therapy|signs and symptoms