Spontaneous rupture of a liver cell adenoma after long term Methyltestosterone: Report of a case successfully treated by emergency right hepatic lobectomy

Abstract

A case of spontaneous rupture of a liver cell adenoma is reported in a female transexual treated with methyltestosterone 150 mg daily for 7 years. Emergency right hepatic lobectomy was performed successfully. Histology showed peliosis hepatis also. Emergency resection of a liver cell adenoma has been reported in a young woman taking oral contraceptives, and an elective resection in another female transexual treated with methyltestosterone. However, to the best of our knowledge this is the first case of emergency resection of a spontaneously ruptured liver cell adenoma in a transexual treated with long term methyltestosterone. Since there are numerous other patients similarly treated, it may be expected that this complication will be seen again.

Histologic Findings in Surgical Pathology Specimens From Individuals Taking Masculinizing Hormone Therapy for the Purpose of Gender Transition

“…76 The findings described by Paradinas et al 76 are similar but less severe than those seen in peliosis hepatis, which is a rare hemorrhagic liver disorder classically showing larger blood-filled spaces and hemorrhage, associated with numerous etiologies including anabolic steroid use. A case of fulminant peliosis hepatis was described in a transgender man by Bird et al 77 In addition, 3 cases of hepatocellular neoplasia have been reported in persons taking masculinizing hormones. The case reported by Bird et al 77 had a concurrent hepatic adenoma.…”

Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of theStandards of Care

“…Cases of hepatic dysfunction and malignancies have previously been observed among men using oral testosterone preparations (Bird, Vowles, & Anthony, 1979;Coombes, Reiser, Paradinas, & Burn, 1978;Futterweit, 1998;Nieschlag & Behre, 1998;Paradinas, Bull, Westaby, & Murray-Lyon, 1977), though a newer preparation of testosterone undecenoate dissolved in castor oil appears to be acceptably safe (Gooren & Bunck, 2004) and is used in Canada and parts of Europe.…”

Endocrine intervention for transsexuals

“…Transient elevation of liver enzymes that cannot be attributed to any other cause is found in approximately 3% of male‐to‐female transsexuals treated with oestrogens and persists for more than 6 months in half of these (van Kesteren et al ., 1997). Case reports of hepatomas (Paradinas et al ., 1977) and spontaneous rupture of a liver cell adenoma (Bird et al ., 1979) have been reported in female‐to‐male transsexuals treated with methyltestosterone, a form of male hormone no longer used.…”