指定課題研究報告
成人成長ホルモン欠乏症患者の転帰及び診断、治療に関する研究
Naomi Hizuka, Makiko Kurimoto, Izumi Fukuda, Junko Morita, Yumiko Okubo, Yuko Murakami, Akira Sata, Kumiko Yasumoto, Yukiko Ishikawa, Kazue Takano Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
AIM
The clinical presentations of patients with adult growth hormone deficiency (GHD) are similar to metabolic syndrome (MS). On the other hand, MS is often associated with non-alcoholic steatohepatitis (NASH) as well as non-alcoholic fatty liver disease (NAFLD). In the present study, we investigated NAFLD and NASH in patients with adult GHD. Moreover, we analyzed a relationship between NAFLD/NASH and MS observed in these patients.
SUBJECTS AND METHODS
Forty patients with adult GHD (F/M: 19/21, 18 - 89 yrs) whose daily alcohol intake was less than 20g, were studied. We investigated the relationship between liver dysfunction, defined as elevated AST and/or ALT, and body mass index (BMI), glucose tolerance and lipid profile.
RESULTS
The median BMI was 23.4 in women and 27.5 in men, respectively. Six women and 13 men had obesity. The frequencies of impaired glucose tolerance, hypercholesterolemia and hypertriglyceridemia were 20%, 55% and 60%, respectively. Liver dysfunction was found in 45% and severe liver dysfunction defined as the levels of AST or ALT more than 100 U/L was found in 7.5%. Fatty liver was detected by ultrasonography in the patients with liver dysfunction and in some with normal liver function. The diagnosis of NASH was confirmed by liver biopsy in three patients. Moreover, two of them had NASH with fibrosis. The prevalence of impaired glucose tolerance and hypercholesterolemia significantly increased in patients with GHD who had liver dysfunction.
CONCLUSIONS
These results demonstrated that patients with GHD were frequently complicated with impaired glucose tolerance, hyperlipidemia and liver dysfunction. The etiology of liver dysfunction was NAFLD in the patients who underwent ultrasonography and NASH who underwent liver biopsy, suggesting that patients with GHD might have an increased risk of NASH. As the NASH is irreversible disease, we have to consider the NASH as a complication of adult GHD.