title: Hepatic hyper-vitaminosis A: importance of retinyl ester level determination.
abstract: We report the case of a 32-year-old man with portal hypertension without cirrhosis due to chronic vitamin A intoxication. Portal hypertension revealed by oesophageal varice rupture progressively worsened and ascites occurred 5 years after the patient stopped vitamin A intake. Initially, serum retinyl palmitate concentration was increased whereas serum retinol concentration was normal. There was no hepatic fibrosis on light microscopic examination of liver biopsy specimens. Five years after the patient stopped excessive vitamin A intake, serum retinol and retinol-binding protein concentrations were below the normal range even though there was an increased hepatic retinyl ester content. This was attributed to the late development of peri-sinusoidal fibrosis. This case mainly shows the importance of retinyl ester level determination: serum retinyl palmitate should be measured immediately after intoxication and hepatic retinyl esters should be measured initially and particularly later. Indeed, later serum and hepatic retinol levels in chronic hyper-vitaminosis A may be normal and lead to under-estimation of liver vitamin A overload.
authors.affiliation: Service d'Hépato-Gastroentérologie, CHU, Angers, France.
authors.forename: V
authors.initials: V
authors.lastname: Croquet
authors.forename: C
authors.initials: C
authors.lastname: Pilette
authors.forename: A
authors.initials: A
authors.lastname: Lespine
authors.forename: E
authors.initials: E
authors.lastname: Vuillemin
authors.forename: M C
authors.initials: MC
authors.lastname: Rousselet
authors.forename: F
authors.initials: F
authors.lastname: Oberti
authors.forename: J P
authors.initials: JP
authors.lastname: Saint André
authors.forename: B
authors.initials: B
authors.lastname: Periquet
authors.forename: S
authors.initials: S
authors.lastname: François
authors.forename: N
authors.initials: N
authors.lastname: Ifrah
authors.forename: P
authors.initials: P
authors.lastname: Calès
mesh_terms: D000328:Adult; D001706:Biopsy; D004224:Diterpenes; D004932:Esophageal and Gastric Varices / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced* / Q000175:diagnosis; D006986:Hypervitaminosis A / Q000097:blood / Q000150:complications*; D008099:Liver / Q000473:pathology; D008297:Male; D012177:Retinol-Binding Proteins / Q000032:analysis; D000084562:Retinyl Esters; D014801:Vitamin A / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D004224:Diterpenes; D012177:Retinol-Binding Proteins; D000084562:Retinyl Esters; D014801:Vitamin A; C014794:retinol palmitate