Severe hepatitis caused by cyproterone acetate

Article Abstract:

Cyproterone acetate, a derivative of the female sex hormone progesterone, acts as an antagonist to the actions of male sex hormones. It is widely used in treating a variety of disorders, including prostate and advanced breast cancer, hypersexuality and sexual deviance in men, and excessive hair growth and acne in women. Abnormalities of liver enzymes and the induction of liver tumors have been reported in animals treated with cyproterone acetate, but little is known about potential liver complications in humans taking this drug. A case is reported of a 71-year-old man treated with daily doses of cyproterone acetate for adenocarcinoma (a cancer) of the prostate. Within two months, he reported nausea, fatigue, and muscle weakness. After 23 weeks of drug treatment, he was admitted to the hospital with jaundice, swollen legs, and severe muscle cramps. He had been taking propranolol (a beta adrenergic blocking agent used to treat cardiac arrhythmias) and nifedipine (a calcium antagonist used for the same purpose) for 10 years. Three weeks following hospital admission, the patient developed tremors of the hands and mental confusion. No evidence was found for liver diseases such as hepatitis, cytomegalovirus, or for other viral or bacterial infections. The mental confusion was characteristic of hepatic encephalopathy (stupor resulting from a failure of the liver to clear ammonia from the blood). Following withdrawal of cyproterone acetate treatment, the patient underwent a prolonged (six weeks of hospitalization), but full recovery. This report, together with the other three reported cases of liver dysfunction during cyproterone acetate treatment, suggest that elderly patients with malignant disease are susceptible to adverse effects of this drug, and should be closely monitored for side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Liver diseases, Drug therapy, Jaundice, Antiandrogens

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Pancreatic pseudocyst causing portal vein thrombosis and pancreatico-pleural fistula

Article Abstract:

Chronic pancreatitis, or inflammation of the pancreas, results from a number of causes including excessive alcohol consumption. The development of a clot (thrombus) in the hepatic portal vein of the liver, and an abnormal opening from the pancreatic ducts to the pleural membrane surrounding the lungs (pancreatico-pleural fistula) are both rare complications of chronic pancreatitis. A case is described of a 36-year-old patient with a history of alcoholism who was being treated for abdominal pain. The detection of elevated blood levels of the pancreatic enzyme amylase led to a diagnosis of pancreatitis. Ultrasound imaging revealed an enlargement of the pancreas. Several months later, he returned for treatment of continuing abdominal pain, and computed tomography scan showed the presence of a pancreatic cyst, with thrombosis (clot formation) in the hepatic portal vein. The patient continued his pattern of excessive alcohol consumption, and the symptoms worsened. Four years after the original diagnosis, he was admitted to the hospital complaining of shortness of breath and chest discomfort. He was found to have pleural effusion (collection of fluid in the space between the lungs and the pleura). Surgical removal of a large portion of the pancreas was planned, but before the operation took place, the patient developed respiratory failure and had to be mechanically ventilated. He subsequently developed thoracic infection with abscess formation, more severe respiratory dysfunction, and kidney failure. Nine weeks after hospital admission, the patient died. At autopsy, the diagnosis of chronic pancreatitis and ulceration of the hepatic portal vein was confirmed; an abnormal conduit (passage) for pancreatic secretions to reach the thoracic space was observed, accounting for the pleural effusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Alcoholism, Pancreatic diseases, Cysts, Pancreatitis, Alcoholic myopathy, Pancreatic cysts

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Congestive gastropathy and Helicobacter pylori: an endoscopic and morphometric study

Article Abstract:

Portal hypertension is a condition characterized by increased blood pressure in the large vein carrying blood from the intestines to the liver (hepatic portal vein), resulting from increased resistance to blood flow through the liver. Congestive gastropathy (congestion of the veins and capillaries of the stomach and intestines) is found in many patients with portal hypertension, and is thought to be responsible for up to 20 percent of the bleeding episodes seen in these patients. The exact anatomical basis of the gastropathy is unknown. To investigate this, and to determine the prevalence of Helicobacter pylori (a gastrointestinal microorganism associated with peptic ulcer and other inflammatory conditions) in portal hypertension-induced bleeding, endoscopy was performed on 74 portal hypertension patients and 20 healthy controls, and the degree of H. pylori infestation was determined in both groups of subjects. The capillaries of the gastric mucosa were dilated (enlarged) in the portal hypertension patients as a group; however, the degree of enlargement was not related to the severity of the portal hypertension. H. pylori infection was detected in 24 percent of the patients with portal hypertension, but was not related to the degree of mucosal capillary dilatation; a greater percentage of portal hypertension patients with normal mucosal capillaries (38 percent) had H. pylori infection than did patients with severe gastropathy (22 percent). Hence, mucosal capillary dilatation is associated with portal hypertension-induced gastropathy, but other factors appear to be more important; H. pylori infection does not appear to be a cause of the condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Helicobacter pylori, Portal hypertension, Gastric mucosa

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