Panhypopituitarism due to Absence of the Pituitary Stalk: A Rare Aetiology of Liver Cirrhosis

Rozas, Marta González; Román, Lidia Hernanz; González, Diego González; Pérez‐Castrillón, José Luis

doi:10.1155/2016/9071097

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…The progression from nonalcoholic fatty liver or NASH to cirrhosis or liver cancer generally takes 57 years and 28 years, respectively, and only 2.5% of NASH patients progress from NASH to cirrhosis or liver cancer[ 61 , 62 ]. Gonzalez Rozas et al [ 63 ] reported a patient with liver cirrhosis due to hypopituitarism. They believed that NAFLD in patients with hypopituitarism may develop rapidly into cirrhosis.…”

Section: Psis and Liver Changesmentioning

confidence: 99%

Pituitary stalk interruption syndrome and liver changes: From clinical features to mechanisms

Wu¹,

Li²,

Chang³

2020

WJG

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Pituitary stalk interruption syndrome (PSIS) is a rare congenital abnormality characterized by thinning or disappearance of the pituitary stalk, hypoplasia of the anterior pituitary and an ectopic posterior pituitary. Although the etiology of PSIS is still unclear, gene changes and perinatal adverse events such as breech delivery may play important roles in the pathogenesis of PSIS. PSIS can cause multiple hormone deficiencies, such as growth hormone, which then cause a series of changes in the human body. On the one hand, hormone changes affect growth and development, and on the other hand, they could affect human metabolism and subsequently the liver resulting in nonalcoholic fatty liver disease (NAFLD). Under the synergistic effect of multiple mechanisms, the progression of NAFLD caused by PSIS is faster than that due to other causes. Therefore, in addition to early identification of PSIS, timely hormone replacement therapy and monitoring of relevant hormone levels, clinicians should routinely assess the liver function while managing PSIS.

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Section: Psis and Liver Changesmentioning

confidence: 99%

Pituitary stalk interruption syndrome and liver changes: From clinical features to mechanisms

Wu¹,

Li²,

Chang³

2020

WJG

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“…31 In addition, liver fibrosis and cirrhosis can develop more rapidly in PSIS patients with NAFLD. 32 In the current study, noninvasive fibrosis scores including NFS and FIB-4 demonstrated that 4.3% of the patients in the NAFLD group exhibited advanced fibrosis, which implicated that most of them remained in the simple steatosis or nonalcoholic steatohepatitis phase. The association between fibrosis and IGF-1 SDS was not determined in our research owing to the limited data, which has been confirmed in other previous studies.…”

Section: Noninvasive Tools For the Risk Stratification Of Fibrosis In...mentioning

confidence: 47%

“…A timely and accurate assessment of liver fibrosis is therefore essential to prevent it from developing into cirrhosis and its advanced complications 31 . In addition, liver fibrosis and cirrhosis can develop more rapidly in PSIS patients with NAFLD 32 . In the current study, noninvasive fibrosis scores including NFS and FIB‐4 demonstrated that 4.3% of the patients in the NAFLD group exhibited advanced fibrosis, which implicated that most of them remained in the simple steatosis or nonalcoholic steatohepatitis phase.…”

Section: Discussionmentioning

confidence: 58%

Relationship between growth hormone deficiency and nonalcoholic fatty liver disease in patients with pituitary stalk interruption syndrome

Huang

Wang

et al. 2022

Clinical Endocrinology

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Background Pituitary stalk interruption syndrome (PSIS), characterized by thinning or disappearance of the pituitary stalk, hypoplasia of the anterior pituitary, and an ectopic posterior pituitary, can lead to congenital combined pituitary hormone deficiency. There is a high prevalence of various metabolic disorders, including nonalcoholic fatty liver disease (NAFLD), in this population. Objective To investigate the characteristics of NAFLD in Chinese adult patients with PSIS and its association with growth hormone deficiency. Design Retrospective cross‐sectional study in a tertiary referral center of China. Patients Adult patients with PSIS diagnosed, followed up between September 2019 and August 2021, were consecutively enrolled. Measurements Abdominal ultrasonography images were evaluated and noninvasive fibrosis scores were determined to assess the severity of NAFLD. Anthropometric, clinical, and biochemical parameters were compared between patients with and without NAFLD. Logistic regression was performed to assess the independent effects of insulin‐like growth factor‐1 (IGF‐1) on NAFLD. Results A total of 93 patients (77 men, 16 women, mean age: 29.6 ± 7.1 years) were included. The prevalence of NAFLD and advanced fibrosis/cirrhosis was 50.5% and 4.3%, respectively. Insufficient hormone therapy and prominent metabolic disorders, including central obesity, dyslipidemia, insulin resistance, and metabolic syndrome, were more common in the NAFLD (+) group. After adjusting for multiple variables, IGF‐1 <−2 standard deviation score (SDS) was found to be associated with an increased prevalence of NAFLD (odds ratio [OR]: 4.92, 95% confidence interval [CI]: 1.21–24.55, p = .035). Per 1 SDS increase in IGF‐1 was associated with a 27% lower risk of NAFLD (OR: 0.73, 95% CI: 0.52–0.97, p = .042). Conclusion NAFLD is a frequent comorbidity among Chinese adult patients with PSIS and is strongly associated with lower IGF‐1 levels. Timely and appropriate hormone replacement, particularly growth hormone may contribute to decreasing the risk of NAFLD in these patients.

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Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism

et al. 2021

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Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%–47%. Chronic liver disease has been described in patients with hypothalamic–pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.

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Panhypopituitarism due to Absence of the Pituitary Stalk: A Rare Aetiology of Liver Cirrhosis

Cited by 3 publications

References 36 publications

Pituitary stalk interruption syndrome and liver changes: From clinical features to mechanisms

Pituitary stalk interruption syndrome and liver changes: From clinical features to mechanisms

Relationship between growth hormone deficiency and nonalcoholic fatty liver disease in patients with pituitary stalk interruption syndrome

Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism

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