Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This is a broad review (140 literature citations) of the possible effects of oral contraceptives on the liver. The oral contraceptives considered consist of combined preparations of estrogens and progestogens although the so-called "minipills" contain only a progestogen. The effects are divided into 1) decrease in excretory liver function; 2) influence on bile acid formation, including cholesterol metabolism; 3) increased synthesis of various transport proteins (ceruloplasmin, transferrin, thyroxine-binding protein, and cortisol-binding protein); 4) the effects of increased tissue circulation caused by sexual hormones and anabolic steroids as a cause for more frequent cavernous angiomas and peliosis hepatis; 5) interference with the metabolism of other drugs by the competitive action of the hepatic metabolites of steroid hormones. This includes the increased formation of delta amino levulinic-acid synthetase, the key enzyme for porphyrin synthesis. The gestagen component of oral contraceptives is responsible for enzyme induction in the smooth endoplasmic reticulum. Morphological liver changes caused by oral contraceptives include parenchyma changes, hepatosis, reactive hepatitis, hepatitis resembling viral hepatitis, vascular changes, sinusoid ectasia, Budd-Chiari syndrome, hyperplasias and neoplasias, focal nodular hyperplasia, adenoma and liver cell carcinoma.
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PMID:[Effects of oral contraceptives on liver function and structure]. 332 30

Six HBsAg negative patients with cirrhosis of the liver (CL) presented with recurrent bouts of palpable purpura in the legs due to small vessel leucocytoclastic vasculitis. In addition, all patients had renal failure, proteinuria and microhaematuria. Renal biopsy disclosed either diffuse proliferative (3 cases) or focal necrotising glomerulonephritis with crescents (2 cases). One patient had IgM-IgG mixed cryoglobulinaemia (type II). Four patients died of complications of their CL. Hepatocellular carcinoma was found in 1 case. In the patient without renal biopsy renal function improved following steroids and cyclophosphamide. The pathogenesis of this syndrome of cutaneous vasculitis with severe glomerular involvement in CL is unknown but could be immune-complex mediated.
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PMID:Renal involvement in a syndrome of vasculitis complicating HBsAg negative cirrhosis of the liver. 399 59

Fanconi's anemia is a rare genetic disorder associated with congenital deformities, infections, chromosomal abnormalities, and leukemia. This brief article describes the case of a 20 year old man affected with the disease, who was given 100 mg daily of oxymetholone to cure leukopenia and thrombocytopenia. 10 months later he died of hepatic failure. Autopsy revealed hepatoma and liver peliosis, a rare condition of unknown etiology characterized by blood-filled cysts in the liver. It is possible that in the case reported here the hepatoma could have been related to the oxymetholone treatment, which conceivably could have initiated hepatic damage.
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PMID:Hepatoma and peliosis hepatis developing in a patient with Fanconi's anemia. 432 28

166 aplastic anaemia patients involved in a cooperative study including androgens were followed up for more than 2 years from the beginning of treatment. The mortality rate from aplasia was low (20% of all cases) after 2 years and nil beyond 5 years. The patients who died were either those who failed to improve but survived 2 years or those who late untreated relapse. Five deaths were due to acute leukaemia, but in 3 of these the diagnosis of aplastic anaemia was retrospectively doubtful. Long-term adverse reactions were rare: 2 cases each of benign hepatoma and peliosis; jaundice was frequent, but no cirrhosis was observed. Survivors who had been treated before puberty reached normal weight and height. Six normal pregnancies occurred. Paroxysmal nocturnal haemoglobinuria was noted in 8 patients with uncontrolled disease. After androgen therapy was discontinued 50% of the patients relapsed with equally or less severe symptoms. Relapses were more frequent when androgens were abruptly withdrawn or in cases with incomplete initial improvement. Most relapses responded to androgen treatment. More than 25% of the patients are still androgen-dependent. With or without maintenance androgen therapy, long-term improvement is incomplete in most cases, which suggests residual bone marrow deficiency, as seen in rodents with experimentally induced aplastic anaemia.
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PMID:[Long-term survival of patients with bone marrow aplasia treated with androgen therapy. 166 cases]. 622 31

The article presents the case of a healthy 29 year old woman, on oral contraception (OC) for a period of 4 years, hospitalized for peliosis hepatis. After radiography revealed the possible existence of an hepatoma, surgery was performed, and an hepatic carcinoma was completely resected. At 45 months after surgery there was no sign of recurrence of the problem. The etiology of peliosis hepatis is still not clear, but there is published evidence of the association between OC and hepatocarcinoma. It is very possible that, at least in the case presented here, peliosis hepatis as well as hepatocarcinoma were caused by prolonged OC treatment.
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PMID:[Peliosis hepatis, oral contraceptives and hepatic carcinoma: a case treated surgically (author's transl)]. 626 68

The hormonal milieu that follows the ingestion of contraceptive agents promotes the growth of hepatic tumors, particularly hepatocellular adenomas. Evidence that the use of contraceptive drugs can also cause carcinoma of the liver is less convincing; this article describes the cases of 2 young women who had taken contraceptives and contracted hepatocellular carcinoma. Both women had no prior history of liver disease and died as a result of the carcinoma. Hepatocellular carcinoma has been a distinctly uncommon disease in the U.S. ranging in incidence from 0.23-0.47% in reported autopsy cases and being typically described as occurring mostly in men over 50 and associated with preexisting cirrhosis. Recent surveys show a greater proportion of female patients; in the U.S. patients at risk now include women in the reproductive age group with no history of prior liver disease. Some recorded changes in the human liver caused by oral contraceptives (OCs) include: 1) impairment of bile secretory function, 2) hepatomegaly associated with peripheral and midzonal sinusoidal congestion, and 3) peliosis hepatis. Significant risk factors in the occurrence of hepatic tumors in OC users are: 1) prolonged usage (1-3 years), 2) age over 30, and 3) use of compounds of high hormonal potency. Products containing mestranol have been implicated to a greater degree than those containing ethinyl estradiol. The link between use of OCs and development of hepatocellular carcinoma is not certain; however, the latter has been firmly linked with the use of anabolic steroids in men. Specifically only the C-17 substituted anabolic steroids oxymetholone and methyltestosterone have been implicated which are closely related to the C-17 substituted 19-norsteroids used in OCs. The following observations have also been made: 1) when hepatocellular carcinoma occurs in women it is mostly in those of reproductive age, and 2) OCs are associated with the development of benign hepatic tumors. Withdrawal from OCs is almost uniformly recommended after definitive diagnosis of a hepatic tumor along with surgery to avoid the risk of rupture and possible mortality.
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PMID:Oral contraceptives and cancer of the liver: a review with two additional cases. 628 82

Many hepatic lesions, ranging from subcellular alterations to malignant tumors, have been attributed to the use of anabolic steroids (AS) and contraceptive steroids (CS). These lesions that have been attributed to AS and CS are discussed with focus on the following: biochemical changes; subcellular alterations; intrahepatic cholestasis; vascular complications (sinusoidal dilatation, peliosis hepatitis, Budd-Chiari syndrome); hyperplasia and neoplasia (diffuse hyperplasia, nodular transformation, focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, and miscellaneous malignant tumors); and miscellaneous effects (effects of preexisting liver disease, cholelithiasis, and pancreatitis). OCs have a number of physiologic effects on the liver. These include decreased bile flow, diminished secretion of organic anions, and decreased synthesis and secretion of bile acids. Retention of bromosulfophthalein has been noted with AS during late pregnancy and in the puerperium. It is well established that the CS can lead to elevations of serum ceruloplasmin and copper levels. Subcellular alterations have been reported in both humans and rats on AS or women on CS and involve multiple organelles of the several systems of the liver. Both AS and CS have been implicated in intrahepatic cholestasis. Jaundice usually develops after 2-5 months of therapy with AS or after 3 months of OC use. The lesions attributed to CS and AS can involve any of the systems of the liver. At times more than 1 system is affected simultaneously. Most of the steroid related lesions resemble similar ones caused by other etiologies. Some, such as peliosis hepatitis, are rarely related to other etiologies, but others can be termed steroid specific. A number of diseases associated with the CS or AS also occur in pregnancy. Acute fatty metamorphosis of pregnancy and the periportal hemorrhagic necrosis characteristic of eclampsia have not been reported in patients on CS. Spontaneous rupture of the liver during pregnancy has not been attributed to the CS.
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PMID:Hepatic lesions caused by anabolic and contraceptive steroids. 628 45

A case of a power weight lifter who is ingesting large doses of anabolic steroids plus other drugs to counteract their short-term side effects is presented. This type of polydrug abuse phenomenon which is unique to the competitive athlete is widespread despite the lack of convincing evidence that anabolic steroids increase muscular strength. The vast extent of this drug abuse problem is poorly appreciated by the general medical community. The potential complications of the long-term usage of these drugs such as liver failure, hepatocellular carcinoma, and peliosis hepatitis make these drugs extremely dangerous.
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PMID:The athletic polydrug abuse phenomenon. A case report. 661 1

The histopathological changes in the livers of 11 patients treated with alkylated and nonalkylated anabolic androgenic steroids are presented. The histological changes in the liver included: proliferation of the bile ducts with or without cystic dilatation (9/11), peliosis (8/11), atypical hyperplasia of liver cells (2/11), and tumors (3/11). The latter included one case of cholangiocarcinoma, one of hepatocellular carcinoma, and one of combined cholangiocellular and hepatocellular carcinoma. The pathological changes in the liver in this series suggest a possible relationship between anabolic androgenic steroids and bile duct proliferation and/or cholangiocarcinoma.
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PMID:Hepatic lesions in patients on anabolic androgenic therapy. 685 30

Fifty-two autopsies of patients who had undergone hemodialysis and had received testosterone enanthate, were reviewed for evidence of peliosis hepatis and liver neoplasms. Eight (15%) pathologic liver were isolated. No peliosis, adenoma or hepatoma was identified. These findings suggest that, unlike the 17-alpha derivatives of testosterone, testosterone enanthate is not associated with morphologic changes in the liver.
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PMID:Absence of peliosis hepatis in patients receiving testosterone enanthate. 720 75


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