S4363 Steatotic Liver Disease Arising in an Asymptomatic 20-Year-old man With Growth Hormone Deficiency
Bibliographic record
Abstract
Introduction: Steatotic liver disease (SLD) may be caused by the presence of cardiometabolic risk factors, viral hepatitis, genetic diseases, malnutrition, or panhypopituitarism. SLD can advance to steatohepatitis where lipid accumulation is accompanied by inflammation and hepatocellular damage. SLD is associated with pituitary dysfunction, especially growth hormone deficiency, as insulin resistance leads to lipid build-up in hepatocytes and oxidative stress. Growth hormone replacement therapy may improve liver steatosis and fibrosis in patients with hypopituitarism. Case Description/Methods: We report a case of a 20-year-old man referred to Hepatology with abnormal liver enzymes. His medical history included panhypopituitarism from a surgically resected pituitary mass, for which he was treated with levothyroxine, hydrocortisone, growth hormone, and testosterone. He presented to Hepatology with markedly elevated liver enzymes (alanine transaminase 556 U/L, aspartate transaminase 258 U/L, alkaline phosphatase 175 U/L, gamma-glutamyl transferase 363 U/L), normal liver function (total bilirubin 15.9 mmol/L, international normalized ratio 1.0, albumin 50 g/L), obesity (weight 93 kg), dyslipidemia (cholesterol 7.2 mmol/L, low-density lipoprotein 4.8 mmol/L), and no evidence of extrahepatic manifestations of chronic liver disease. Work-up for secondary causes of liver disease including infectious, autoimmune, drug-induced, and genetic were negative. Abdominal ultrasound revealed moderate hepatic steatosis with mild hepatomegaly and splenomegaly. His liver enzymes remained elevated and his biochemical liver function remained normal despite discontinuation of hepatotoxic medications. Liver biopsy showed grade II/III steatohepatitis with stage III-IV fibrosis (Figure 1) and FibroScan liver stiffness score was 21.8 kPa. The biopsy results suggested that panhypopituitarism, specifically growth hormone deficiency, and metabolic dysfunction, contributed to his liver disease. Discussion: This is a unique case of an aggressive form of SLD that likely developed after the onset of altered growth hormone signaling and growth hormone replacement therapy did not improve abnormal liver enzymes or liver damage. Physicians should recognize SLD as a complication of growth hormone deficiency and follow patients with bloodwork and imaging given the risk of disease progression.Figure 1.: A. Liver parenchyma showing macrovesicular steatosis (*) and steatohepatitis including hepatocytes with ballooning degeneration and poorly-formed Mallory-Denk bodies (arrows) and inflammation (arrowheads). B. The same area with extensive pericellular “chicken wire” fibrosis. Masson trichrome stain, 300x.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".