title: Resolution of non-alcoholic steatohepatitis after growth hormone replacement in a pediatric liver transplant patient with panhypopituitarism.
abstract: NAFLD is a common condition linked to obesity, type 2 diabetes, and metabolic syndrome. Simple hepatic steatosis is a risk factor for inflammatory reactions in the liver (NASH), which may lead to cirrhosis. While the mechanism is unclear, NAFLD and NASH are associated with panhypopituitarism, which in the pediatric population often results from craniopharyngioma or pituitary adenoma and the sequelae of treatment, causing hypothyroidism, adrenal insufficiency, hypogonadotropic hypogonadism, and GH deficiency. Refractory NAFLD in panhypopituitarism may be amenable to GH replacement. Here, we report a pediatric case of NASH secondary to panhypopituitarism from craniopharyngioma, which recurred by 11 months after LDLT. Despite low-dose GH replacement, the patient remained GH deficient. Pubertal dosed GH therapy led to rapid and complete resolution of hepatic steatosis, which we tracked using serial1H MRS. Pediatric patients with NASH cirrhosis secondary to panhypopituitarism can be good candidates for liver transplantation, but hormone deficiencies predispose to recurrence after transplant. High-dose GH replacement should be considered in pediatric patients with GH deficiency and recurrent disease. A multidisciplinary team approach is essential for successful outcomes.
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gilliland
authors.affiliation: Howard Hughes Medical Institutes, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Dufour
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Howard Hughes Medical Institutes, Yale University School of Medicine, New Haven, CT, USA.|Novo-Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Gerald I
authors.initials: GI
authors.lastname: Shulman
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.|Novo-Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Kitt Falk
authors.initials: KF
authors.lastname: Petersen
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sukru H
authors.initials: SH
authors.lastname: Emre
mesh_terms: D000293:Adolescent; D005355:Fibrosis / Q000209:etiology; D019382:Human Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000188:drug therapy*; D016031:Liver Transplantation; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D019382:Human Growth Hormone
keywords: growth hormone deficiency; liver steatosis; liver transplantation; non-alcoholic fatty liver disease; panhypopituitarism