Pituitary‐testicular function in patients with alcoholic cirrhosis of the liver

Abstract

In forty-two patients with alcoholic liver cirrhosis and without recent alcohol ingestion the pituitary-testicular function was studied in an effort to relate the endocrine abnormalities with the degree of liver cell dysfunction, evaluated on a quantitative basis. Compared with values in twenty-one healthy controls, we found significantly elevated serum oestrone, oestradiol, follicle-stimulating hormone, luteinizing hormone and prolactin (P less than 0.01). Serum dehydro-epiandrosterone and dehydroepiandrosterone sulphate were significantly reduced in the cirrhotics (P less than 0.01), whereas serum testosterone was not significantly different from that in the controls. Raised levels of sex-hormone binding globulin were found in 71% (22/31) of the patients (median 8 x 10(-18) mol/l, range 3-17 x 10(-8) mol/l). The incidence of gynaecomastia (38%), cutaneous spiders (67%), testicular atrophy (24%) and reduced axillary hair (71%) was without significant relation to raised levels of sex-hormone binding globulin or progressively reduced liver function. In the presence of clinical or hormonal hypo-gonadism we found evidence of a state of primary hypogonadism together with an inadequate secretion of gonadotropins. The state of hyperoestrogenaemia and the concentration of gonadotropins were significantly correlated to the hepatic synthesis of coagulation factors.

Androgens and oestrogens before and following oral testosterone administration in male patients with and without alcoholic cirrhosis

“…The basal serum concentrations of binding pro¬ teins and of the major part of the sex steroids in men with alcoholic cirrhosis reported in this study are in accordance with previous studies (Morgan 1982;Bahnsen et al 1981). In contrast with some studies (Morgan 1982;Franz et al 1979), the present was unable to demonstrate significantly decreased serum concentrations of testosterone, non-protein bound testosterone, dihydrotestoste¬ rone, and oestrone sulphate.…”

“…Other studies, however, have been unable to demonstrate this difference (Morgan 1982;Gluudetal. 1981;Bahnsen et al 1981). …”

“…These patients have significantly raised concentrations of oestrogens (Morgan 1982;Bahnsen et al 1981). Owing to a further increase in oestrogens following testo¬ sterone injection (Kley et al 1979) it has been feared that administration of aromatizable anabolic-androgenic steroids to these patients might be detrimental (Lester et al 1979).…”

The effects of diet on circulating sex hormone levels in men

“…Crosssectional analyses have also reported con¯icting results on the association between habitual moderate alcohol intake and testosterone concentration (Dai et al 1981;Stefanick et al 1987;Key et al 1990a;Field et al 1994;Wu et al 1995;Ferrini & Barrett-Connor, 1998). However, long-term heavy alcohol consumption and its associated liver cirrhosis, as well as general liver failure, has been consistently associated with low testosterone concentrations (Distiller et al 1976;Valimaki et al 1982) and a high SHBG concentration (Bahnsen et al 1981).…”

Dermatological manifestations of chronic liver disease

“…Nail changes in cirrhosis includes clubbing, thickening of nails, longitudinal ridging, white bands (Muehrke's bands), and brittle nails. 10,11 Those with advanced cirrhosis can present with Terry's nails characterized by a ground glass opacity of nail plate which turns powdery white at its proximal end. 12 Bluish discoloration of lunulae may be found in patients with Wilson's disease known as Azure lunulae.…”