Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism

Eman Alabsawy; Yassen Serry; Sreelakshmi Kotha; Philip Berry; Giovanni Tritto

doi:10.1136/bcr-2021-244805

Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism

BMJ Case Rep. 2021 Sep 20;14(9):e244805. doi: 10.1136/bcr-2021-244805.

Authors

Eman Alabsawy^{1

2}, Yassen Serry³, Sreelakshmi Kotha³, Philip Berry³, Giovanni Tritto³

Affiliations

¹ Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK [email protected].
² Faculty of Medicine, Alexandria University, Alexandria, Egypt.
³ Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Abstract

Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%-47%. Chronic liver disease has been described in patients with hypothalamic-pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.

Keywords: cirrhosis; pituitary disorders; pulmonary hypertension; transplantation.

Publication types

Case Reports

MeSH terms

Adult
End Stage Liver Disease*
Fibrosis
Hepatopulmonary Syndrome* / diagnosis
Hepatopulmonary Syndrome* / diagnostic imaging
Humans
Hypopituitarism* / complications
Hypopituitarism* / diagnosis
Liver Cirrhosis / complications
Male