CHANGES OF SEX-HORMONE LEVELS IN PATIENTS WITH HEPATITIS-B VIRUS-RELATED POSTNECROTIC CIRRHOSIS - RELATIONSHIP TO THE SEVERITY OF PORTAL-HYPERTENSION

The effect of portal hypertension on plasma sex steroid levels was stu died in 49 patients with hepatitis B virus-related postnecrotic cirrho sis. In accordance with the Child-Pugh classification, 18 patients wer e classified as grade A, 15 grade B and 16 grade C. At the same time, 25 males who were admitted for physical check-up served as normal cont rols. Serum testosterone levels decreased (3.31 +/- 2.03 vs. 5.65 +/- 0.13 ng/ml) and estrone levels increased (0.16 +/- 0.08 vs. 0.09 +/- 0 .02 ng/ml) significantly in patients with cirrhosis compared to the le vels obtained in the controls. Moreover, these changes were associated with an increased severity of cirrhosis (P < 0.05 when severity incre ased from grade A to C). Hemodynamic values regarding hepatic venous p ressure gradient and cardiac output demonstrated significant differenc es in patients from grade A to C, but the correlation between these tw o parameters was poor (r = 0.3242). The hepatic venous pressure gradie nt, the only direct measurement of portal hypertension, did not correl ate with any of the measured hormone levels in patients with cirrhosis . There was, however, a highly significant negative correlation betwee n cardiac output and testosterone levels (r = -0.8754, P < 0.01) and a positive correlation between cardiac output and estrone levels (r = 0 .7522, P < 0.05) in grade C patients. On the basis of these results, w e concluded that gonadal dysfunction is a common finding in patients w ith heaptitis B related postnecrotic cirrhosis, especially in those wi th decompensated liver function. The relationship between cardiac outp ut and severity of liver disease suggests that the degree of portosyst emic shunting probably increases as liver disease worsens. The availab le hemodynamic data, however, only provide information about the corre lation between cardiac output and sex hormone levels in grade C patien ts. There is no direct evidence which supports the role of portal hype rtension per se in the generation of these endocrine changes.