Naomi Hizuka, Makiko Kurimoto, Yu Yamakado, Izumi Fukuda, Junko Morita, Yumiko Okubo, Kazue Takano
Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
INTRODUNCTION
@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). We have investigated NAFLD and NASH in 76 patients with adult GHD, and found as follows: 1) liver dysfunction was found in 40% of the patients, 2) the prevalence of liver dysfunction significantly increased in patients with hypertriglyceridemia, and in male patients with abnormal glucose metabolism and/or obesity, 3) the etiology of liver dysfunction was NAFLD in the patients who underwent ultrasonography, 4) Moreover, all of the patients (N=5) who underwent liver biopsy were diagnosed as NASH. These data suggested that patients with GHD might have an increased risk of NASH.
@In the present study, we investigated clinical characteristics of five adult GHD with NASH.
CASES WITH NASH
@Clinical characteristics of five adult GHD with NASH are shown in Table 1.
@The age, sex, and onset in the five patients were 19 - 56 (median: 36) years old, two female/three male, and two childhood-onset (CO)/three adulthood-onset (AO), respectively. The GH peak to GH provocative test, IGF-I SD score, and BMI (median; range) were 0.1 (0.05 - 0.1) Ęg/L, -2.8 (-6.1 - -0.45) SD, and 28.3 (24.5 - 40.2) kg/m2, respectively. The etiologies of GHD in the CO-GHD were one craniopharyngioma and one idiopathic, and in the AO-GHD, two craniopharyngiomas and one Sheehan syndrome.
@All patients had ACTH, TSH, LH/FSH deficiency, and three had AVP deficiency. The adequate replacement therapy except GH have been carried out in these patients. All patients had hypertriglyceridemia, four had diabetes mellitus, and three had hypercholesterolemia and low HDL-cholesterol levels.
CONCLUSIONS
@These data demonstrate that adult GHD patients with NASH are frequently associated with abnormal lipid and glucose metabolism. As the NASH is able to progress rapidly, we have to consider the NASH as an important complication of adult GHD.
