Hypothalamic-pituitary-gonadal axis in cirrhotic patients in Imam Khomeini Hospital, Tehran

Hypogonadism is a major complication in cirrhosis that affects quality of life to a great extent, and therefore, its treatment and prevention is very important. The main purpose of this study is to determine whether this hypogonadism is the result of central (hypothalamic) changes or gonadal disorders. In this study, we studied 36 cirrhotic patients in 3 Child groups (12 patients in each group) and 12 normal controls. Physical examination of patients for detecting the signs of hypogonadism was done and all mecessary tests were requested (serum levels of LH, FSH, estradiol, Testostrone, DHEA, SHBG) and compared in groups with ANOVA and Post –Hoc tests. In cirrhotic patients, frequency of hypogonadism signs were as follows: decreased sexual desire (77.8%), Impotence (52.8%), erectile dysfunction (41.7%), gynecomastia (38.9%) and change of hair pattern (22.2%). Comparison of serum levels of hormones in different child groups and controls showed that with progression of disease severity, testosterone decreased, estradiol and SHBG increased and LH and FSH didnt’ show significant changes compared with control group. Also, DHEA didn’t show significant change with progression of disease severity After GnRH stimulation test each group showed significant increase in the levels of LH and FSH that is in favor of hypothalamic disorder. This study shows that hypogonadism in cirrhotic patients is of central (hypothalamic) origin and in its treatment this must be considered.