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Case report
Hepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarism
  1. Eman Alabsawy1,2,
  2. Yassen Serry1,
  3. Sreelakshmi Kotha1,
  4. Philip Berry1 and
  5. Giovanni Tritto1
  1. 1Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. 2Faculty of Medicine, Alexandria University, Alexandria, Egypt
  1. Correspondence to Dr Eman Alabsawy; eman.alabsawy{at}gstt.nhs.uk

Abstract

Hepatopulmonary syndrome (HPS) is characterised by the development of intrapulmonary arteriovenous blood shunts and vascular dilatation with consequent hypoxaemia, usually in the context of end-stage liver disease (ESLD). The estimated incidence of HPS in ESLD has been reported to be 13%–47%. Chronic liver disease has been described in patients with hypothalamic–pituitary dysfunction, mainly in the form of non-alcoholic fatty liver disease due to metabolic syndrome, with occasional progression to cirrhosis. We report a challenging case of a 27-year-old man with a background of hypopituitarism with no known liver disease who presented with progressive dyspnoea and hypoxaemia and was eventually diagnosed with severe HPS.

  • pituitary disorders
  • cirrhosis
  • pulmonary hypertension
  • transplantation

https://doi.org/10.1136/bcr-2021-244805

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    Footnotes

    • Twitter @EmanIbr02688658

    • Contributors EIA: Consenting, conception and design, acquisition of data and references, writing up draft and a member of the management team. YS: Collecting data and investigations results and writing up part of the draft. SK: Conception and design and revising the draft, with final approval of the version for publication. PB: Conception and design, revising the draft with final approval of the version for publication and senior member of the management team. GT: Conception and design, revising the draft with final approval of the version for publication and senior member of the management team.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.