ESTRADIOL AND TESTOSTERONE BLOOD-LEVELS IN PATIENTS WITH VIRAL CIRRHOSIS AND HEPATOCELLULAR-CARCINOMA

Background: Patients with alcoholic cirrhosis show hypogonadism and fe minization associated with sex hormone imbalance due to enhanced aroma tization of testosterone and subsequent reduced testosterone and incre ased oestradiol blood levels. Because oestrogens modulate hepatocyte p roliferation and oestrogen receptors are present in liver cirrhosis an d hepatocellular carcinoma, it has been proposed that sex hormone imba lance can play a role in liver carcinogenesis. Trials with the oestrog en receptor antagonist tamoxifen have been performed with conflicting results. Objectives: To investigate oestradiol and testosterone blood levels in men with viral cirrhosis and hepatocellular carcinoma and al so to investigate changes in sex hormone circulating levels induced by tamoxifen treatment. Patients and methods: Oestradiol and testosteron e blood levels were evaluated in 32 male patients with postviral cirrh osis and hepatocellular carcinoma at the time of diagnosis and during the follow-up, and in 20 healthy controls. In eight patients, hormone levels were also assayed during treatment with tamoxifen (40 mg/day). No patient had a history of high alcohol intake. Results: Oestradiol v alues observed at the time of diagnosis were 56.1 +/- 54.5 pmol/l, whi le testosterone values were 13.6 +/- 8.0 pmol/l. There was no relation ship between oestrogen values and age, while higher oestradiol values were observed in patients with advanced cirrhosis (Child B and C); con versely, testosterone levels progressively and significantly decreased from cirrhosis Child A (15.1 +/- 9.7) to C (7.7 +/- 7.1) (P<0.05). Ta moxifen treatment (40 mg/day) for 1 month in eight patients increased oestradiol values (62.2 +/- 77.0 vs. 156.4 +/- 83 pmol/l, P<0.05), whi le testosterone levels decreased (15.1 +/- 6.8 vs. 8.5 +/- 10.6 pmol/l ). However, these changes were not associated with clinical signs or s ymptoms of feminization. Oestrogen levels decreased after 6 months of tamoxifen treatment. No significant change in hormone levels was obser ved in patients not treated with tamoxifen. Unlike patients with alcoh olic cirrhosis, in male patients with viral cirrhosis and hepatocellul ar carcinoma there were no significant alterations in blood oestradiol and testosterone levels, although a certain degree of sex hormone imb alance was observed in those with advanced cirrhosis. Treatment with t amoxifen (40 mg/day) did not induce clinical manifestations of sex hor mone imbalance.