A Study of Hormonal Abnormalities in Chronic Liver Disease.

BACKGROUND

The liver, being involved in multiple metabolic processes, not only impacts the endocrine system normally but also become an inevitable target during the course of endocrine disorders. The effects of this intricate relationship which may be disrupted in CLD can only be addressed by simultaneously studying all hormone profiles in such patients and also their relation to etiology and severity of CLD.

METHODS

Serum fasting cortisol, insulin, prolactin, testosterone, estradiol, FSH, LH and thyroid hormones (TSH, free T4 & T3) were measured for any abnormality in 100 randomly selected patients of CLD in a cross sectional observational study and their relation to etiology and severity of CLD (estimated by MELD and CTP score) were studied.

RESULTS

Cortisol, estradiol and insulin levels were significantly higher in alcoholics, the former two also increased with severity of CLD. There was overt hypothyroidism in 19% and subclinical hypothyroidism 43% patients, especially those with chronic hepatitis C and autoimmune hepatitis. Testosterone levels were lower in males. Other hormonal changes were independent of severity or etiology of CLD. Cortisol and insulin levels were significantly higher in diabetics with CLD.

CONCLUSION

Significant alterations of hormonal profile starting early in the development of CLD of any etiology occur which may need treatment or close follow up. ALD may have worse outcome due to disturbed metabolism of sex hormones, cortisol and insulin. The normal endocrine homeostasis of the body may become disrupted in presence of CLD which may also influence outcome.