Glycogenic hepatopathy: A narrative review

Area of Science:

• Hepatology
• Endocrinology
• Diabetology

Background:

• Glycogenic hepatopathy (GH) is a rare complication of poorly controlled diabetes mellitus.
• It presents as transient liver dysfunction, hepatomegaly, and elevated liver enzymes due to reversible glycogen accumulation in hepatocytes.
• Predominantly seen in type 1 diabetes, it's also reported in type 2 diabetes, adolescents, and adults.

Purpose of the Study:

• To review the pathogenesis, evaluation, differential diagnosis, and management of glycogenic hepatopathy.
• To highlight the need for further research into biochemical defects, diagnostic tests, and long-term consequences like fibrosis.
• To increase awareness of GH among medical professionals.

Main Methods:

• Literature review of English-language publications on glycogenic hepatopathy.
• Discussion of clinical presentation, pathophysiology, diagnostic methods, and management strategies.
• Comparison with non-alcoholic fatty liver disease (NAFLD) and its diagnostic differentiation.

Main Results:

• GH is characterized by reversible glycogen accumulation in hepatocytes, often linked to wide fluctuations in glucose and insulin levels.
• Gradient dual-echo MRI can differentiate GH from NAFLD, but liver biopsy remains the gold standard for diagnosis.
• Adequate glycemic control can lead to complete remission of GH-related abnormalities, though recent reports indicate potential liver fibrosis.

Conclusions:

• Glycogenic hepatopathy is a reversible condition in diabetics with proper glucose management.
• Further research is essential to understand underlying mechanisms, develop noninvasive diagnostics, and assess the impact of associated liver fibrosis.
• Increased medical awareness is crucial for timely diagnosis and management.