Evaluation of the hypothalamic-pituitary-gonadal axis and prevalence of hypogonadism in men and women with liver cirrhosis

Miriam C. Oliveira Alvaro Cassal Cristina B. Pizarro About the authors

Liver cirrhosis (LC) is one of the chronic diseases associated to hypogonadism (HG), which has a varied etiology in relation to the target organ of the gonadal axis affected. We evaluated 82 patients with LC of different etiologies, to ascertain the prevalence of HG. Non-physiological HG was diagnosed in 63 cases (76,8%). This diagnosis was initially established on clinical bases. In men, loss of libido (68,8%), erectile dysfunction (53,8%), female distribution of pubic hair (53,1%), testicular atrophy (55,3%), and gynecomastia (48%) were detected. In women, amenorrhea during fertile age was present in 18 cases (78,2%). Diagnosis of hypothalamus-pituitary alteration was possible only through GnRH testing, where the LH peak was significantly lower in hypogonadal patients. The frequency of central HG predominated: 90,4% of the cases. There was no difference in the duration of liver disease between HG and eugonadal patients. Severity of cirrhosis, evaluated according to CHILD’s classification, significantly correlated to the presence of central HG. There was no significant association between the presence of HG or isolated symptoms, as reduced libido or gynecomastia, and concomitance of acute or chronic illnesses, hyperprolactinemia or the use of drugs. In conclusion, the findings were prominent in relation to the frequency of HG, especially in women, and the predominance of a central etiology, possibly as a response to the poor metabolic conditions of the patients. Diagnosis of HG in patients with LC demands continued medical attention.

Liver cirrhosis; Hypogonadism; Central hypogonadism; Testosterone; Amenorrhea

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