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Impact of vascular liver disease on the menstrual cycle and metabolic status in premenopausal women - 12/01/22

Doi : 10.1016/j.clinre.2021.101756 
Tatiana Stempak-Droissart a, b, Christine Rousset-Jablonski c, Poli M Spritzer a, d, Najiba Lalhou e, Etienne Larger f, Caroline Pichard g, Aurélie Plessier h, Anne Gompel a,
a Université de Paris, Department of Gynecological Endocrinology, Hôpitaux Universitaires Centre, AP-HP, Paris, France 
b Department of Obstetrics and Gynecology, Groupe hospitalier Sud Ile de France, Centre hospitalier de Melun, Melun, France 
c Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France 
d Division of Endocrinology, Hospital de Clinicas de Porto Alegre and Department of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil 
e Laboratory of Hormonal Biology, Groupe hospitalier Cochin-Port Royal, AP-HP, Paris, France 
f Université de Paris, Department of Diabetology, Groupe hospitalier Cochin-PorRoyal, AP-HP, Paris, France 
g Department of Endocrinology and metabolic diseases, Groupe hospitalier La Pitié-Salpêtrière, APHP, Paris, Fance 
h Beaujon Hospital, AP-HP, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Inserm U1149, Centre de Recherche sur l'Inflammation (CRI), Paris, Université Paris 7-Denis-Diderot, ERN Rare liver Clichy, France 

Corresponding author at: Hôpital Port-Royal, 123 bd de l'Hôpital, Paris, 75014, France.Hôpital Port-Royal, 123 bd de l'HôpitalParis75014France

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Highlights

Vascular liver diseases are associated with menstrual cycle and endocrine abnormalities.
Clinical and/or biological features of hyperandrogenism are frequent in these women.
Increase in SHBG and decrease in IGF1 could be viewed as the hallmark of hepatic failure.
Progestin contraception is well tolerated in these women.

El texto completo de este artículo está disponible en PDF.

Abstract

Background

Vascular liver disease (VLD) are rare liver diseases, which affect women at reproductive ages. Main complications are bleeding (portal hypertension, thrombopenia or anticoagulation related) and thromboembolism. Failure of liver function can occur. Thus endocrine abnormalities management and contraception are challenging.

Purpose

to evaluate the impact on the menstrual cycles and related endocrine abnormalities in women with VLD and respective roles of liver function and portal hypertension.

Study design

This was a single-center observational cohort study. Forty-seven premenopausal women with vascular liver disease were included for endocrine and gynecological assessments. Endocrine evaluation was performed at inclusion. Tolerance of contraception was followed up and assessed at 3 and 12 months.

Participants, Setting, Methods

Forty-seven women (aged 16–50) followed in a Reference Center for Liver Vascular Disease between February 2009 and November 2016 were included and addressed for gynecological and endocrinological management. Twenty-five women had extrahepatic portal vein obstruction, 17 had Budd Chiari Syndrome and five had a porto-sinusoidal vascular disease. We explored gonadotropin at baseline and after GnRH, testosterone, sex hormone binding globulin (SHBG), androstenedione, GH axis and glucose metabolism. All women underwent pelvic ultrasonography.

Results

Vascular liver disease was associated with abnormal menstrual cycles in 53% of the women and clinical and/or biological hyperandrogenism and/or a polycystic ovary morphology was identified in 38%. Portal hypertension was correlated to higher testosterone levels (P = 0.04), whereas higher elevated levels SHBG in 28%, correlated with liver failure (P = 0.01). Sixteen had glucose intolerance profile or diabetes. IGF-1 levels were highly correlated with hepatic failure. Abnormal uterine bleeding occurred in 21% of women, 87% of which were due to gynecological pathologies revealed by anticoagulant treatment. Progestin contraception was well tolerated and helped to control bleeding.

Conclusion and implications

endocrine abnormalities, prior described in association with cirrhosis, are also identified in patients with vascular liver disease, and require specific management. Glucose intolerance profile is frequent, further studies are needed to assess significant consequences on cardio-vascular system.

El texto completo de este artículo está disponible en PDF.

Keywords : Budd-Chiari syndrome, Portal vein thrombosis, Portal hypertension, Hyperandrogenism, Contraception, IgF-1


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Vol 46 - N° 1

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