Dysfunction of the hypothalamic-pituitary-glandular axes and relation to Child-Pugh classification in male patients with alcoholic and virus-related cirrhosis

Eur J Gastroenterol Hepatol. 2003 May;15(5):495-501. doi: 10.1097/01.meg.0000059115.41030.e0.


Objective: To investigate anterior pituitary function (adrenal, somatotropic, thyroid and gonadal axes, and prolactin) in relation to the Child-Pugh score in male patients with alcoholic and virus-related liver cirrhosis.

Method: Anterior pituitary function was evaluated in 52 male cirrhotics (26 Child-Pugh class A (CPA), 16 Child-Pugh class B (CPB) and 10 Child-Pugh class C (CPC)) by a combined pituitary stimulation test, and was compared with 50 age-matched controls.

Results: A normal cortisol response to corticotropin-releasing hormone (CRH) stimulation was demonstrated in 57.6% of CPA patients, 31.1% of CPB patients and 20% of CPC patients, while basal levels of adrenocorticotropic hormone (ACTH) and cortisol in cirrhotics were comparable to those in controls. Levels of basal growth hormone (P < 0.001) and stimulated growth hormone (P < 0.01) were significantly higher in cirrhotics compared with controls, while levels of insulin-like growth factor 1 (IGF-1) were significantly lower (P < 0.001). Basal prolactin levels were elevated significantly in CPC patients (P < 0.01), while stimulated prolactin as well as basal and stimulated thyroid-stimulating hormone (TSH) levels were comparable. Basal luteinizing hormone levels were significantly higher in CPA (P < 0.001) and CPB (P < 0.001) patients, and stimulated luteinizing hormone levels were significantly lower in CPC patients than in controls (P < 0.005). Basal and stimulated follicle-stimulating hormone (FSH) levels were comparable in all groups. Child-Pugh score was correlated positively to prolactin and was correlated negatively to IGF-1, stimulated luteinizing hormone and free testosterone.

Conclusions: In cirrhotics, the hypothalamic-pituitary-adrenal and -gonadal axes and prolactin secretion are impaired. Growth hormone response to growth hormone-releasing hormone (GHRH) is accelerated in cirrhotics. Thus, elevated basal and stimulated levels of growth hormone probably reflect compensation for low levels of IGF-1, which are associated with deteriorating liver function. The aetiology of cirrhosis was found to have no influence on the degree of alteration of the hypothalamic-pituitary-glandular axes.

MeSH terms

  • Adult
  • Aged
  • Gonadal Steroid Hormones / blood
  • Hepatitis, Viral, Human / blood
  • Hepatitis, Viral, Human / physiopathology*
  • Human Growth Hormone / blood
  • Humans
  • Hypothalamo-Hypophyseal System / physiopathology*
  • Insulin-Like Growth Factor I / metabolism
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / physiopathology*
  • Liver Cirrhosis, Alcoholic / blood
  • Liver Cirrhosis, Alcoholic / physiopathology
  • Male
  • Middle Aged
  • Pituitary-Adrenal System / physiopathology*
  • Prolactin / metabolism
  • Severity of Illness Index
  • Sex Hormone-Binding Globulin / metabolism


  • Gonadal Steroid Hormones
  • Sex Hormone-Binding Globulin
  • Human Growth Hormone
  • Insulin-Like Growth Factor I
  • Prolactin