Effect of liver transplantation on sex-hormone disorders in male patients with alcohol-induced or post-viral hepatitis advanced liver disease

Guéchot, Jérôme; Chazouillères, Olivier; Loria, Alain; Hannoun, L.; Balladur, Pierre; Parc, R; Giboudeau, J; Poupon, Raoul

doi:10.1016/s0168-8278(94)80020-0

Cited by 48 publications

(59 citation statements)

References 19 publications

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“…The biochemical bases of these phenomena were shown in the present study and in others. Testosterone serum level is lower than in normal patients (5,7,9) which masks a marked fall in the non-protein-bound (biologically active) fraction of the hormone due to a large increase in the sex hormone-binding globulin (SHBG) (3,7,10) which binds testosterone with a high affinity. Most circulating testosterone is bound SHBG and only the small proportion in the free form is biologically active (8,13) .…”

Section: Resultsmentioning

confidence: 91%

“…In addition, the increase in SHBG leads to a stronger binding with testosterone (8,13) . In cirrhotic patients occur an increase in the peripheral conversion of androgens into estrogens (4,6,7) and a decrease in the liver depuration of estrogens. Southern et al (16) also reported that accelerated conversion of testosterone to androstenedione may explain, in part, the presence of increased circulating estrogens in cirrhosis, since it has been reported that androstenedione is a more efficient precursor than testosterone for estrogen synthesis.…”

Section: Resultsmentioning

confidence: 99%

“…It involves both a gonadal and a hypothalamic-pituitary dysfunction (7,18) which is shown in laboratory tests by a decrease in gonadotropins (FSH and LH), total testosterone and FT serum levels. Karagiannis et al (11) showed that after OLT the hypothalamic-pituitarygonadal function improves partially, showing that the hepatic dysfunction before OLT is important in its pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

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Testosterone Changes in Patients With Liver Cirrhosis Before and After Orthotopic Liver Transplantation and Its Correlation With Meld

Nitsche

Coelho

Freitas

et al. 2014

Arq. Gastroenterol.

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Context Hypogonadism is a common clinical situation in male patients with liver cirrhosis. Objectives The aim of the present study was to evaluate the effects of orthotopic liver transplantation on testosterone, free testosterone and sex hormone-binding globulin in male with advanced liver disease and also to determine the relationship of these changes with Model for End-stage Liver Disease (MELD) score. Methods In a prospective study, serum levels of testosterone, free testosterone and sex hormone-binding globulin of 30 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. Results Total testosterone levels increased after orthotopic liver transplantation and the number of patients with normal testosterone levels increased from 18 to 24. Free testosterone mean level in the pre-transplant group was 7.8 pg/mL and increased to 11.5 pg/mL (P = 0.10) and sex hormone-binding globulin level decreased after orthotopic liver transplantation returning to normal levels in MELD ≤18 - group (A) (P<0.05). Conclusions Serum level changes of testosterone, free testosterone and sex hormone-binding globulin are more pronounced in cirrhotic males with MELD ≤18. Serum levels of testosterone and free testosterone increase and serum levels of sex hormone-binding globulin decrease after orthotopic liver transplantation.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Testosterone Changes in Patients With Liver Cirrhosis Before and After Orthotopic Liver Transplantation and Its Correlation With Meld

Nitsche

Coelho

Freitas

et al. 2014

Arq. Gastroenterol.

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“…Testicular atrophy, decrease in libido, impotence, oligospermia, infertility, loss of body hair, reduction of prostate size, gynecomastia, vascular spiders, gynecoid distribution of fat and palm erythema are often found in cirrhotic men [5][6][7][8][9][10] . These findings are more pronounced in patients with alcoholic cirrhosis due to the direct harmful effect of ethanol to the testicles.…”

mentioning

confidence: 99%

Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation

Zacharias

Coelho

Parolin

et al. 2014

Rev. Col. Bras. Cir.

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In a prospective study, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) of 30 male patients with cirrhosis were determined two to four hours before and six months after liver transplantation. The results were compared according to the Model for End-stage Liver Disease (MELD). Results Results ResultsResults Results: male patients with liver cirrhosis have hypogonadism. FSH was normal, but inappropriately low due to androgen failure; E2 and PRL, on their turn, were high. After liver transplantation, FSH and LH levels increased (p < 0.05), whereas E2 and PRL normalized (p < 0.05). The MELD score did not influence changes in FSH, PRL and LH, however, the more severe the cirrhosis was, the more significant was the normalization of E2 (p = 0.01). Conclusion Conclusion Conclusion Conclusion Conclusion: Patients with cirrhosis and male hypogonadism have inappropriately normal levels of FSH and LH, associated with an increase in E2 and LRP. After liver transplantation, FSH and LH increased, while E2 and PRL returned to normal. Changes in E2 levels were most pronounced in patients with MELD > 18. The severity of cirrhosis had no influence on FSH, PRL and LH.

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“…Most of the time, despite the generalized advanced gonadal failure, gonadotropin levels are low, indicating involvement of the hypothalamus-pituitary axis. The site of this disorder is the hypothalamus since these patients do not present the usual LH pulsatility (18), since exogenous GnRH stimulates LH and FSH (19)(20)(21) and since the picture of hormonal deficiency is reversed after liver transplant (21)(22)(23). The secretory status of the a-subunit has not been established in this form of hypogonadism.…”

Section: Introductionmentioning

confidence: 99%

Pituitary glycoprotein hormone <FONT FACE=Symbol>a</font>-subunit secretion by cirrhotic patients

Oliveira¹,

Pizarro²,

Cassal

et al. 1999

Braz J Med Biol Res

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Secretion of the a-subunit of pituitary glycoprotein hormones usually follows the secretion of intact gonadotropins and is increased in gonadal failure and decreased in isolated gonadotropin deficiency.The aim of the present study was to determine the levels of the asubunit in the serum of patients with cirrhosis of the liver and to compare the results obtained for eugonadal cirrhotic patients with those obtained for cirrhotic patients with hypogonadotropic hypogonadism. Forty-seven of 63 patients with cirrhosis (74.6%) presented hypogonadism (which was central in 45 cases and primary in 2), 7 were eugonadal, and 9 women were in normal menopause. The serum a-subunit was measured by the fluorimetric method using monoclonal antibodies. Cross-reactivity with LH, TSH, FSH and hCG was 6.5, 1.2, 4.3 and 1.1%, respectively, with an intra-assay coefficient of variation (CV) of less than 5% and an interassay CV of 5%, and sensitivity limit of 4 ng/l. The serum a-subunit concentration ranged from 36 to 6253 ng/l, with a median of 273 ng/l. The median was 251 ng/l for patients with central hypogonadism and 198 ng/l for eugonadal patients. The correlation between the a-subunit and basal LH levels was significant both in the total sample (r = 0.48, P<0.01) and in the cirrhotic patients with central hypogonadism (r = 0.33, P = 0.02). Among men with central hypogonadism there was a negative correlation between a-subunit levels and total testosterone levels (r = -0.54, P<0.01) as well as free testosterone levels (r = -0.53, P<0.01). In conclusion, although the a-subunit levels are correlated with LH levels, at present they cannot be used as markers for hypogonadism in patients with cirrhosis of the liver.

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Effect of liver transplantation on sex-hormone disorders in male patients with alcohol-induced or post-viral hepatitis advanced liver disease

Cited by 48 publications

References 19 publications

Testosterone Changes in Patients With Liver Cirrhosis Before and After Orthotopic Liver Transplantation and Its Correlation With Meld

Testosterone Changes in Patients With Liver Cirrhosis Before and After Orthotopic Liver Transplantation and Its Correlation With Meld

Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation

Pituitary glycoprotein hormone <FONT FACE=Symbol>a</font>-subunit secretion by cirrhotic patients

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