Liver Transplantation in a Woman with Mahvash Disease

N Engl J Med. 2023 Nov 23;389(21):1972-1978. doi: 10.1056/NEJMoa2303226.

Abstract

Mahvash disease is an exceedingly rare genetic disorder of glucagon signaling characterized by hyperglucagonemia, hyperaminoacidemia, and pancreatic α-cell hyperplasia. Although there is no known definitive treatment, octreotide has been used to decrease systemic glucagon levels. We describe a woman who presented to our medical center after three episodes of small-volume hematemesis. She was found to have hyperglucagonemia and pancreatic hypertrophy with genetically confirmed Mahvash disease and also had evidence of portal hypertension (recurrent portosystemic encephalopathy and variceal hemorrhage) in the absence of cirrhosis. These findings established a diagnosis of portosinusoidal vascular disease, a presinusoidal type of portal hypertension previously known as noncirrhotic portal hypertension. Liver transplantation was followed by normalization of serum glucagon and ammonia levels, reversal of pancreatic hypertrophy, and resolution of recurrent encephalopathy and bleeding varices.

Publication types

  • Case Reports

MeSH terms

  • Esophageal and Gastric Varices / etiology
  • Esophageal and Gastric Varices / surgery
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / surgery
  • Genetic Diseases, Inborn* / blood
  • Genetic Diseases, Inborn* / diagnosis
  • Genetic Diseases, Inborn* / genetics
  • Genetic Diseases, Inborn* / surgery
  • Glucagon* / blood
  • Glucagon* / genetics
  • Glucagon-Secreting Cells / pathology
  • Humans
  • Hypertension, Portal* / blood
  • Hypertension, Portal* / etiology
  • Hypertension, Portal* / genetics
  • Hypertension, Portal* / surgery
  • Hypertrophy / genetics
  • Liver Cirrhosis
  • Liver Transplantation*
  • Pancreatic Diseases / genetics
  • Pancreatic Diseases / pathology
  • Pancreatic Diseases / surgery

Substances

  • Glucagon