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#Gastroenterology #Hepatology #Multispeciality
Mounting evidences have suggested that an interrelationship exists between the endocrine system and the liver. Several interactions such as several metabolic reactions and processes of protein synthesis in the liver is regulated by hormones, while liver is considered as the major site for hormone metabolism. Hormones in the liver may either be transformed into more active compounds such as thyroxine into the four times as active triidothyronine, vitamin D3 into its 25-OH form or be inactivated, catabolized and eliminated. In addition, liver has the ability to impact hormone blood levels, as it is the site of transport protein synthesis and also acts as an important source of hormone-dependent growth factors and of their inhibitors. These occurrence of complex interactions between hormones and liver is mediated via receptors and hence, specific membrane, cytoplasmic, and nuclear receptors for various hormones can be found in liver tissue. The presence of specific receptors modulates the concentrations and efficacy of hormonal actions and its binding capacity can be altered by the specific binding hormone and other hormones as well. It has been observed that estrogens may increase both estrogen and prolactin (PRL) receptors while testosterone decreases estrogen and PRL binding. Moreover, liver possesses receptors for sexual hormones with properties comparable to those in hormone-dependent sexual target tissues. Some experimental studies have also shown that variations exist between male and female steroid-metabolizing enzymes in the liver; as male livers have more oxidizing enzymes and female livers have more reducing enzymes; females have estrogen and PRL receptors while males have androgen along with estrogen, but not PRL receptors.
Various clinical trials have demonstrated that both estrogens and androgens are employed in the process of hepatic regeneration. Moreover, a link exist between liver focal nodular hyperplasia and hepatocellular adenoma and oral contraceptive or anabolic steroid intake. Besides, certain studies have concluded that androgenic anabolic steroids may promote the growth of both hepatocellular adenoma and carcinoma. Therefore, in view of these strong interactions, it can be assumed that multiple endocrine imbalance can occur in patients with liver disease. This has been validated by few clinical trials that showed hypogonadism and feminization occur mainly in patients with alcoholic liver cirrhosis. Furthermore, both alcohol toxicity and liver damage can influence several endocrine functions.
Source: Langer M, Chiandussi L. Hormones and Liver: Some Aspects of the Problem. Assessment and Management of Hepatobiliary Disease pp 217-225. Available at: https://link.springer.com/chapter/10.1007/978-3-642-72631-6_29