title: Intravenous glucocorticoid therapy for Graves' ophthalmopathy and acute liver damage: an epidemiological study.
abstract: OBJECTIVE
  Intravenous glucocorticoid (i.v.GC) pulse therapy for Graves' ophthalmopathy (GO) can be associated with acute liver damage (ALD), which was roughly estimated to occur in ∼1% of patients, with an overall mortality of 0.4%. The aim of this study was to evaluate the frequency of ALD after the introduction of a series of exclusion criteria and preventive measures.
  
  
  METHODS
  Retrospective evaluation of all consecutive patients candidate to i.v.GC over a period of 5 years.
  
  
  METHODS
  The study includes 376 GO patients candidate to i.v.GC. Several liver tests were performed before, during, and after i.v.GC. To prevent ALD morbidity and mortality, the following measures were applied: i) exclusion of patients with active viral hepatitis and/or severe liver steatosis; ii) reduction in the GC dose, frequency, and number of pulses; and iii) administration of oral GC after i.v.GC, and also during i.v.GC in patients positive for nonorgan-specific autoantibodies (to prevent autoimmune hepatitis due to immune rebound). ALD was defined as an increase in alanine aminotransferase ≥ 300 U/l.
  
  
  RESULTS
  A total of 353 patients were given i.v.GC and 23 were excluded for various conditions. ALD was detected in 4/376 patients candidate to i.v.GC, resulting in a morbidity of 1.06%. One patient recovered spontaneously and three after additional treatment with oral GC, given to re-establish immune suppression in the suspect of an autoimmune hepatitis.
  
  
  CONCLUSIONS
  ALD related to i.v.GC is a relatively rare adverse event. Provided an accurate selection of patients and a series of preventive measures are applied, i.v.GC is a safe treatment for the liver.
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Eleonora
authors: E
authors: Sisti
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Barbara
authors: B
authors: Coco
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Francesca
authors: F
authors: Menconi
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Marenza
authors: M
authors: Leo
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Roberto
authors: R
authors: Rocchi
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Francesco
authors: F
authors: Latrofa
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Maria Antonietta
authors: MA
authors: Profilo
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Barbara
authors: B
authors: Mazzi
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Eleonora
authors: E
authors: Albano
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Paolo
authors: P
authors: Vitti
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Claudio
authors: C
authors: Marcocci
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
authors: Maurizia
authors: M
authors: Brunetto
authors: Endocrinology Unit IDepartment of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124 Pisa, ItalyHepatology UnitUniversity Hospital of Pisa, Via Paradisa 2, 56124 Pisa, Italy michele.marino@med.unipi.it.
authors: Michele
authors: M
authors: Marinò
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D049970:Graves Ophthalmopathy / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D000410:Alanine Transaminase; D008775:Methylprednisolone