Endocrine Abstracts

Background: Several clinical features of chronic liver disease, such as sarcopenia, anaemia, low bone mass and gynecomastia are similar as manifestation of hypogonadism. Decreased testosterone levels are common in patients with severe liver disease and are associated with worse clinical outcomes and mortality.

Case Presentation: A 33-year-old patient was admitted to the hospital due to severe alcoholic hepatitis. He was in poor general condition, icteric, encephalopathic with peripheral edema and mild ascites. Due to high Maddrey score, corticosteroid therapy was initiated, leading to a gradual decrease in bilirubin and liver enzymes but his clinical condition remained poor. The patient lost 23 kg of body mass within 2 months and his body mass index (BMI) was 21 kg/m2. The SARC-F score (Strength-Assistance walking-Rice from a chair-Climb Stairs-Falls) was 4. Laboratory findings suggested hypogonadotropic hypogonadism (LH 1.92 IU/l, FSH 1.65 IU/l) with very low free testosterone levels (32 pmol/l, ref. range 170 - 660) corrected for albumin and SHBG. Transdermal therapy with 25 mg/day of testosterone gel was initiated. Liver enzymes were slightly elevated (< 1.5 ULN) at the time of administration of testosteron and glucocorticoid therapy was discontinued. A month later, free testosterone was 151 pmol/l and there was a clinical increase in muscle strength and mobility. Dose of 50 mg/day was continued. Body mass further increased (BMI 24 kg/m2); the patient became fully independent in performing physical tasks while free testosterone reached normal levels (251 pmol/l). Liver parameters improved and no side effects occurred. We decided to continue testosterone therapy until further recovery of liver function.

Conclusion: Due to high incidence of hypogonadism, testosterone levels should be assessed in younger patients with severe liver diseases. The transdermal administration of testosterone therapy avoids hepatic circulation and prevents potential occurrence of hepatotoxic effects. It dramatically improved frailty in our patient and similar results have already been described, but this therapeutic option is still not widely prescribed. Further research on long term risk and benefits of transdermal testosterone therapy in chronic liver diseases is required.