A young patient with type 2 diabetes associated non-alcoholic steatohepatitis, liver cirrhosis, and hepatocellular carcinoma

Abstract

The rising prevalence of the metabolic syndrome has led to an increase of non-alcoholic fatty liver disease (NAFLD), and its progressive-inflammatory form called non-alcoholic steatohepatitis (NASH). In recent years, NAFLD and NASH have become major risk factors for developing liver cirrhosis and hepatocellular carcinoma (HCC). In this case, we report a 46-year-old patient with type 2 diabetes mellitus and metabolic comorbidities including obesity and arterial hypertension, who was referred because of rising liver enzymes. After clinical and diagnostic evaluation, the patient was diagnosed with NASH-associated liver cirrhosis, Child-Pugh stage B. A normal blood sugar level was difficult to achieve, and the patient presented with consistently elevated HbA1c-levels irresponsive to insulin therapy. Due to the underlying liver cirrhosis, the patient was enrolled in the HCC-surveillance program. Sonography during follow up showed a focal lesion. On magnetic resonance imaging (MRI), the diagnosis of HCC (BCLC stage A) was confirmed based on typical contrast enhancement and portal-venous wash-out. The patient was evaluated for liver transplantation with a labMELD of 17, and an intermittent therapy with TACE was initiated. Only 2 months after liver transplantation, the patient developed severe and lethal complications. Overall, this case highlights the different medical issues of patients with metabolic syndrome developing a chronic liver disease. In this patient, a rapid progression from NASH-associated liver cirrhosis to HCC was seen, and therefore highlights the importance of close surveillance to identify and treat potential risk factors early in the course of the disease.

Leberspezifische Diagnostik bei der nichtalkoholischen Fettlebererkrankung (NAFLD) – wann kann die Leberbiopsie ersetzt werden?

“…Diese beiden Formen sind durch das Vorliegen von Entzündung im Leberläppchen (lobuläre Inflammation) und die Schädigung von Hepatozyten (Ballonierung) definiert [6]. Anhaltende Entzündungs-und Regenerationsprozesse in der Leber führen zur hepatischen Fibrose und können letztlich in eine terminale Leberschädigung münden, gekennzeichnet durch das Entstehen einer Leberzirrhose oder die Entwicklung eines hepatozellulären Karzinoms (HCC) [7].…”

Rs3746444 T>C locus in miR-499 increases the susceptibility to hepatocellular carcinoma: A meta-analysis 14812 subjects

“…To date, the etiology of HCC is not well established. Although it has been reported that chronic virus infection[ 4 ], type 2 diabetes[ 5 , 6 ], obesity[ 7 , 8 ], smoking[ 9 , 10 ], heavy alcohol intake[ 11 - 13 ] and aflatoxin-contaminated food stuffs[ 14 ] may contribute to the occurrence of HCC, other risk factors may also lead to the development of HCC, such as hereditary factors[ 15 - 18 ].…”

Impact of Non-Alcoholic Fatty Liver Disease on Metabolic Comorbidities in Type 2 Diabetes Mellitus

“…Data from smaller studies exploring the PPAR agonist pioglitazone [8], the Glp-1 agonist liraglutide [9] and more recently semaglutide [10] have shown a benefit on NASH resolution in controlled trials. Additionally, case-control studies have suggested that metformin is protective with regards to the development of hepatocellular carcinoma (HCC) [11], while insulin adds to the risk of HCC development [12,13].…”