Growth hormone deficiency and NAFLD: An overlooked and underrecognized link

Growth hormone and its mediator insulin-like growth factor-1 exert their effect on different organs and control various physiologic metabolic processes. Adult growth hormone deficiency (AGHD) presents with one or more components of metabolic syndrome and can be associated with nonalcoholic fatty liver disease (NAFLD). AGHD is present in spectrum of hypothalamic/pituitary disorders as well as cranial radiation of brain tumors and often remains underdiagnosed or untreated due to its nonspecific symptoms, relatively difficult diagnosis in some clinical scenarios, and various barriers to treatment. NAFLD usually develops soon after diagnosis of AGHD and might progress rapidly to nonalcoholic steatohepatitis (NASH) with advanced fibrosis, eventually requiring liver transplantation. A timely initiation of growth hormone replacement therapy might be important, although studies so far have demonstrated controversial results on NAFLD, primarily due to small sample size and different diagnostic methods of NAFLD. Increased awareness of the association between AGHD and NAFLD would facilitate early diagnosis of NAFLD and NASH if present. Therefore, a multidisciplinary approach involving hepatology and endocrinology should become a standard of care for these patients.

Automated summary

Growth hormone and insulin-like growth factor-1 have effects on different organs and metabolic processes. Adult growth hormone deficiency (AGHD) is associated with nonalcoholic fatty liver disease (NAFLD), which is often underdiagnosed or untreated. NAFLD usually progresses rapidly after AGHD diagnosis and may require liver transplantation. Increased awareness of the association between AGHD and NAFLD is needed to facilitate early diagnosis.