Hypothalamic-pituitary-gonadal function in men with cirrhosis of the liver.

Abstract

SUMMARY Hypothalamic-pituitary-gonadal function was studied in 37 cirrhotic males, 25 of whom were alcoholic. Irrespective of aetiology, cirrhotic patients had significantly reduced free testosterone concentrations. Despite low free testosterone concentrations and reduced or absent spermatogenesis, basal levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were normal in nearly all patients, suggesting impaired function of the hypothalamic-pituitary-gonadal axis. In 14 cirrhotic men, seven of whom had gynaecomastia, the ability of the pituitary to secrete LH and FSH in

Plasma oestrogens in men with chronic liver disease.

“…An indirect action-for instance, at hypothalamic-pituitary level-is another possibility. Pituitary function tests performed in these patients have suggested that, in feminised patients only, there may be a circulating inhibitor of gonadotrophin releasing hormone (Mowat et al, 1976). It might be that E1 acts in this way.…”

“…The hyperoestrogenic state thus induced in cirrhotic males would then explain both the hypogonadism (by direct suppression of pituitary gonadotrophins) and also the feminisation. Many studies have recently confirmed the hypogonadism by demonstrating reduced circulating unbound plasma testosterone concentrations and oligospermia or azoospermia in cirrhotic males (Chopra et al, 1973;Galvao-Teles et al, 1973;Mowat et al, 1976), but studies on oestrogens and their metabolites are less conclusive (Adlercreutz, 1974). The early finding of increased urinary oestrogens during the course of acute liver disease using biological assay methods (Gilder and Hoagland, 1946;Llamosa and Gomez Mont, 1953) was not confirmed when biochemical methods of measurement were used (Gregoris, 1957;Miller, 1958).…”

Multihormonal Pituitary Adenomas

“…In liver cirrhosis an increased peripheral conversion of androstendione to estrone and of testosterone to estradiol takes place in fat tissue (1). Despite the low serum testosterone concentrations, basal serum levels of gonadotropins were in the normal range in the majority of 37 male cirrhotics (25). In some patients, an exaggerated LH response to gonadotropin-releasing hormone was obtained.…”

HIV-1 or hepatitis C chronic infection in serodiscordant infertile couples has no impact on infertility treatment outcome

“…Note that one possible bias should be taken into consideration. As expected, many HCV-infected patients suffered liver disease that may in itself impair the fertility (21).…”