From liver to hormones: The endocrine consequences of cirrhosis

Figure 1 Pathophysiology of liver cirrhosis and associated endocrinopathies. A: Pathophysiology of liver cirrhosis (LC); B: Pathophysiology of the endocrinopathies associated to LC. AD: Antidiabetic drug; AVP: Arginine vasopressin; BCAA: Branched-chain amino acid; BP: Blood pressure; GH: Growth hormone; IGF-1: Insulin-like growth factor 1; IGFBP: Insulin-like growth factor binding protein; RAAS: Renin-angiotensin-aldosterone system; SHBG: Sex hormone-binding globulin; SNS: Sympathetic nervous system; T3: Triiodothyronine; T4: Thyroxine.

Figure 2 Summary of diagnostic tests used in the approach to endocrinopathies associated with liver cirrhosis. The asterisk (*) represents that adrenal insufficiency should be evaluated if there is refractory hypotension, sodium less than 125 mmol/L, and high-density lipoproteins less than 0.39 mmol/L. BMD: Bone mineral density; BMI: Body mass index; CGM: Continuous glucose monitoring; CT: Computed tomography; DXA: Dual-energy X-ray absorptiometry; FIB-4 index: Fibrosis-4 index; FSFI: Female Sexual Function Index; FSH: Follicle-stimulating hormone; FT: Free testosterone; GH: Growth hormone; HbA1c: Hemoglobin A1c; IGF-1: Insulin-like growth factor 1; IIEF: International Index of Erectile Function; IV: Intravenous; L3: 3^rd lumbar vertebrae; LH: Luteinizing hormone; LLN: Lower limit of normality; MRI: Magnetic resonance imaging; OGGT: Oral glucose tolerance test; PA: Primary aldosteronism; PAC: Plasma aldosterone concentration; POI: Primary ovarian insufficiency; PRA: Plasma renin activity; PRC: Plasma renin concentration; PRL: Prolactin; SHBG: Sex hormone-binding globulin; TSH: Thyroid-stimulating hormone; TT: Total testosterone.