Zhu JW, Yan J, Zhang ZH, Wang TQ. Mild liver injury following withdrawal of long-term prednisone therapy: A case report. World J Gastroenterol 2025; 31(4): 102135 [DOI: 10.3748/wjg.v31.i4.102135]
Corresponding Author of This Article
Tian-Qi Wang, PhD, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Zhengzhou University, No. 100 Kexue Avenue, Zhengzhou 450001, Henan Province, China. tianqi@zzu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jan 28, 2025; 31(4): 102135 Published online Jan 28, 2025. doi: 10.3748/wjg.v31.i4.102135
Mild liver injury following withdrawal of long-term prednisone therapy: A case report
Jing-Wen Zhu, Jun Yan, Zhi-Han Zhang, Tian-Qi Wang
Jing-Wen Zhu, Jun Yan, Zhi-Han Zhang, Tian-Qi Wang, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Co-first authors: Jing-Wen Zhu and Jun Yan.
Author contributions: Zhu JW and Yan J are listed as co-first authors; Zhu JW, Yan J, and Zhang ZH contributed to data collection and literature search; Wang TQ contributed to data collection, literature search, and drafting and revision of the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-Qi Wang, PhD, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Zhengzhou University, No. 100 Kexue Avenue, Zhengzhou 450001, Henan Province, China. tianqi@zzu.edu.cn
Received: October 9, 2024 Revised: December 2, 2024 Accepted: December 17, 2024 Published online: January 28, 2025 Processing time: 81 Days and 18 Hours
Abstract
BACKGROUND
Liver injury manifesting as hepatic enzyme abnormalities, has been occasionally identified to be a feature of primary or secondary Addison's disease, an uncommon endocrine disease characterized by adrenal insufficiency. There have been no more than 30 reported cases of liver injury explicitly attributed to Addison's disease. Liver injury resulting from adrenal insufficiency due to glucocorticoid withdrawal is exceptionally rarer.
CASE SUMMARY
A 42-year-old man presented with fatigue and mildly elevated transaminases. Laboratory investigations and imaging studies excluded common etiologies of liver injury. Based on the fact that the patient discontinued long-term therapy with prednisone approximately 2 weeks before he was found to have elevated transaminase levels and the observation that his cortisol was lower than the normal value, he was diagnosed as having hypertransaminasemia secondary to adrenal insufficiency caused by glucocorticoid withdrawal. The patient was infused intravenously with compound diisopropylamine dichloroacctate and compound glycyrrhizin, and his transaminase levels returned to normal after 1 week. Approximately 2 years later, the patient received hydroprednisone treatment for 2 days in an endoscopic sinus surgery. Eight days after he discontinued the hydroprednisone treatment, he developed symptoms reminiscent of glucocorticoid withdrawal syndrome. These symptoms resolved spontaneously after 1 week. Intriguingly, the patient did not develop hepatic dysfunction this time.
CONCLUSION
The present case, showing some unusual clinical features, highlights the importance of education of clinicians and patients to avoid improper discontinuation of glucocorticoid therapy and complete history taking for prompt recognition.
Core Tip: This paper describes a rare case of mild hypertransaminasemia occurring following withdrawal of long-term prednisone therapy, a condition that is potentially underestimated and easily ignored. The presented case suggests that hypertransaminasemia caused by glucocorticoid withdrawal may have different features from hypertransaminasemia due to primary Addison's disease; the severity of adrenal insufficiency may be associated with the development of elevated transminases and their levels; and glycyrrhizin may be an option for patients with mild adrenal insufficiency due to glucocorticoid withdrawal who have planned to discontinue this hormonal therapy.
