Pituitary function test and endocrine status in patient with cirrhosis of the liver before and after hepatic transplantation.

Objective: Hormonal alterations caused by chronic liver disease are well described. In contrast, the reversibility of peripheral hormonal changes after orthotopic liver transplantation (OLT) has only partially been analyzed since the establishment of OLT as treatment of chronic hepatic failure. In addition it is not finally verified if chronic liver failure and especially hepatic encephalopathy also affect pituitary function. We therefore performed extensive endocrine studies including a global pituitary stimulation test before and after liver transplantation.

Methods: 22 patients with chronic alcoholic and non alcoholic liver failure were included in this prospective study. Basal hormone values (ACTH, cortisol, FSH, GH, IGF-I, LH, oestradiol, PRL, thyroid hormones and testosterone) were measured before and up to 5 years after OLT. Furthermore all patients underwent pituitary function tests with application of GRF, TRH, GnRH, and CRF before, 3 weeks and 3 months after OLT.

Results: Estradiol, LH and FSH increased significantly in postmenopausal and only slightly in premenopausal female patients after OLT. Total testosterone revealed no marked changes and was normal before and up to five years after OLT in male patients. After stimulation with GnRH the LH response in females and the FSH response in males was significantly higher three months after OLT than pretransplant. LH response in males and FSH response in females was only slightly higher after OLT. Peripheral IGF-I was low and growth hormone was elevated in all patients prior OLT. Growth hormone declined significantly three months afterwards. The response to GRF was highest prior OLT and decreased afterwards. Prolactin values were normal prior and post OLT. After stimulation with TRH prolactin values in male patients were significantly higher before OLT than afterwards.

Conclusion: In the observed relatively small number of patients gross pituitary function in chronic liver failure remained intact, whereas slight alterations in several axis were found. These pituitary alterations are presumably only partially caused by feedback mechanisms. Both a normalisation of peripheral endocrine parameters and pituitary function were achieved by OLT despite significant alterations pretransplant.