Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4852-4858
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4852
Growth hormone cocktail improves hepatopulmonary syndrome secondary to hypopituitarism: A case report
Wen Ji, Min Nie, Jiang-Feng Mao, Hong-Bing Zhang, Xi Wang, Xue-Yan Wu
Wen Ji, Jiang-Feng Mao, Xi Wang, Xue-Yan Wu, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Min Nie, Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
Hong-Bing Zhang, Department of Physiology, Collaborative Innovation Center for Cancer Medicine, Institute of Basic Medical Sciences and School of Basic Medicine, Beijing 100005, China
Author contributions: The patient was followed by Ji W under Wu XY’s guidance; Nie M, Mao JF, and Zhang HB reviewed the literature and contributed to manuscript drafting; Wang X analyzed and interpreted the imaging findings; all authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81771576 and No. 81971375; and the Beijing Municipal Natural Science Foundation, No. 7202151 and No. 7212080.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Yan Wu, MD, Professor, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuai Fuyuan, Dong Cheng District, Beijing 100730, China. wsheyan@vip.sina.com
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 29, 2021
Revised: April 2, 2021
Accepted: April 20, 2021
Article in press: April 20, 2021
Published online: June 26, 2021
Processing time: 122 Days and 20.5 Hours
Abstract
BACKGROUND

Metabolic associated fatty liver disease frequently occurs in patients with hypopituitarism and growth hormone (GH) deficiency. Some patients may develop to hepatopulmonary syndrome (HPS). HPS has a poor prognosis and liver transplantation is regarded as the only approach to cure it.

CASE SUMMARY

A 29-year-old man presented with progressive dyspnea for 1 mo. At the age of 10 years, he was diagnosed with panhypopituitarism associated with pituitary stalk interruption syndrome. Levothyroxine and hydrocortisone were given since then. To achieve ideal height, he received GH treatment for 5 years. The patient had an oxygen saturation of 78% and a partial pressure of arterial oxygen of 37 mmHg with an alveolar–arterial oxygen gradient of 70.2 mmHg. Abdominal ultrasonography showed liver cirrhosis and an enlarged spleen. Perfusion lung scan demonstrated intrapulmonary arteriovenous right-to-left shunt. HPS (very severe) was our primary consideration. His hormonal evaluation revealed GH deficiency and hypogonadotropic hypogonadism when thyroid hormone, cortisol, and desmopressin were administrated. After adding with long-acting recombinant human GH and testosterone for 14 mo, his liver function and hypoxemia were improved and his progressive liver fibrosis was stabilized. He was off the waiting list of liver transplantation.

CONCLUSION

Clinicians should screen HPS patients' anterior pituitary function as early as possible and treat them primarily with GH cocktail accordingly.

Keywords: Hepatopulmonary syndrome; Testosterone; Growth hormone; Intrapulmonary shunt; Insulin-like growth factor; Case report

Core Tip: Liver transplantation is currently known to be the only way to cure hepatopulmonary syndrome (HPS). Even after the successful transplantation surgery, metabolic associated fatty liver disease (MAFLD) always recurs in patients with hypopituitarism who do not receive appropriate hormone replacement therapy. We present herein a case of HPS (very severe) induced by panhypopituitarism that was recovered by complete hormone replacement without surgery, especially growth hormone and testosterone. This case report highlights the importance of screening anterior pituitary function in patients with MAFLD or HPS as early as possible. The growth hormone cocktail therapy, especially growth hormone and testosterone, is expected to avoid liver transplantation.