From liver to hormones: The endocrine consequences of cirrhosis

Abstract

Hepatocrinology explores the intricate relationship between liver function and the endocrine system. Chronic liver diseases such as liver cirrhosis can cause endocrine disorders due to toxin accumulation and protein synthesis disruption. Despite its importance, assessing endocrine issues in cirrhotic patients is frequently neglected. This article provides a comprehensive review of the epidemiology, pathophysiology, diagnosis, and treatment of endocrine disturbances in liver cirrhosis. The review was conducted using the PubMed/Medline, EMBASE, and Scielo databases, encompassing 172 articles. Liver cirrhosis is associated with endocrine disturbances, including diabetes, hypoglycemia, sarcopenia, thyroid dysfunction, hypogonadotropic hypogonadism, bone disease, adrenal insufficiency, growth hormone dysfunction, and secondary hyperaldosteronism. The optimal tools for diagnosing diabetes and detecting hypoglycemia are the oral glucose tolerance test and continuous glucose monitoring system, respectively. Sarcopenia can be assessed through imaging and functional tests, while other endocrine disorders are evaluated using hormonal assays and imaging studies. Treatment options include metformin, glucagon-like peptide-1 analogs, sodium-glucose co-transporter-2 inhibitors, and insulin, which are effective and safe for diabetes control. Established standards are followed for managing hypoglycemia, and hormone replacement therapy is often necessary for other endocrine dysfunctions. Liver transplantation can address some of these problems.

Keywords: Diabetes mellitus; Hypoglycemia; Thyroid diseases; Hypogonadism; Metabolic bone diseases; Liver cirrhosis

Core Tip: This review explores hepatocrinology, the interplay between liver function and the endocrine system, focusing on endocrine disorders in liver cirrhosis. Cirrhosis triggers endocrine disorders like diabetes, hypoglycemia, sarcopenia, hepatic bone disease, secondary hyperaldosteronism, and thyroid, adrenal and growth hormone dysfunction. Diagnosis includes biochemical and hormonal assays and imaging studies. Treatment involves drugs like metformin, insulin, and hormone replacement therapies, while liver transplantation can alleviate certain conditions. Timely recognition and intervention are crucial for reducing associated morbidity and mortality in cirrhotic patients.