Endocrine Abstracts

Introduction: Data on sexual dysfunction (SD) in cirrhotic patients are limited. Sexual function is a complex area of human behavior with great impact on quality-of-life (QOL). Despite its relevance, it is rarely evaluated in clinical practice in cirrhotic patients. Indeed, published studies are heterogeneous, differ in the way sexual function is assessed, and usually evaluate only one specific aspect of sexual life. Our aim was to evaluate in detail the sexual function of patients with end-stage liver disease in the waiting list for liver transplantation (LT) and to compare it to that of a controlled group from the general population matched by age and gender.

Methods: Changes in sexual functioning questionnaire, Short Form 36 Health Survey and the Hospital Anxiety and Depression Scale were used to evaluate SD, QOL and psychiatric comorbidity, respectively. Clinical data as well as a complete set of sexual hormonal profile were obtained. Controls were given the same questionnaires.

Results: Fifty three patients, 68% men with a median MELD 18, were included and compared to 22 controls. 96% had SD, which was more severe in older patients, those using spironolactone, and those suffering from anxiety. QOL was significantly impaired compared to controls. Central hypogonadism and hyperestrogenemia was present in most men. Blood levels of sexual hormones were similar in the alcoholic liver disease group compared to those of other etiology. In addition, low levels of DHEA-S were found in 97% of men. Total cholesterol and fractional cholesterol, precursors of sexual hormones correlated significantly with the level of total and free testosterone, free androgen index, SHBG and DHEA-Sulphate.

Conclusion: SD, an infra-estimated condition, is extremely common in cirrhotic patients awaiting LT. SD is likely a key factor in the impaired QOL typical of these patients. Factors associated with worsening of sexual function include advanced age, chronic spironolactone use and presence of anxiety disorders. Besides central hypogonadism, the reduced levels of DHEA, possibly due to adrenal dysfunction, is an aspect that deserves further investigation. Sexual dysfunction could, in part, be another manifestation of the recently coined ‘hepatoadrenal syndrome’.