Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatits in Patients with Childhood-Onset Adult Growth Hormone Deficiency

Abstract

Patients with growth hormone deficiency (GHD) often have obesity, hyperlipidemia, fatty liver and diabetes mellitus which are similar to metabolic syndrome. Recently, it has been reported that non-alcoholic fatty liver disease (NAFLD), especially with non-alcoholic steatohepatits (NASH) are associated with metabolic syndrome. Therefore, it is interesting to know the relationship between GHD and NASH/NAFLD. In the present study, we investigated NASH/NAFLD in patients with childhood-onset adult GHD. A retrospective chart analysis was performed on 38 patients (M/F 19/19, age 35 ± 11, range 18-62) with childhood-onset GHD who visited our outpatient clinic. Clinical course, symptoms and laboratory data were reviewed in these patients. The average body mass index (BMI) and the value of HOMA-R of the patients were 24.9 ± 3.8 kg/m² and 3.09 ± 2.9, respectively. Liver dysfunction was found in 17 patients. We performed abdominal ultrasonography on 7 of 17 patients with liver dysfunction, and observed fatty liver change in all patients. The majority of these patients had impaired glucose tolerance and dyslipidemia by the time of diagnosis of NAFLD. Moreover, microscopic examination of liver biopsy specimens from one patient revealed NASH with fibrosis. In conclusion, patients with GHD are at risk of excessive weight gain, impaired glucose tolerance, and dyslipidemia with subsequent development of NAFLD. As NAFLD is related to the occurrence of NASH and cirrhosis, this novel evidence that GHD may be accompanied by progressive NAFLD has important implications for follow-up and management of patients with GHD.