Exploring Gonadal Functions in Patients With Alcoholic Liver Disease: A Correlative Analysis With Disease Severity

Background and objective Alcoholic liver disease (ALD) encompasses a spectrum of liver conditions caused by excessive alcohol consumption, including fatty liver, alcoholic hepatitis, and cirrhosis. Both phenotypical and biochemical changes in gonadal hormones are observed across these stages. This study aimed to evaluate the clinical, biochemical, and hormonal abnormalities in patients with varying degrees of ALD and to assess their correlation with disease severity. Methodology A cross-sectional study was conducted at Lady Hardinge Medical College, New Delhi, involving 150 patients with ALD who were categorized into three groups: fatty liver (n=45, 30.0%), alcoholic hepatitis (n=30, 20.0%), and chronic liver disease (CLD) (n=75, 50.0%). Clinical, biochemical, and hormonal profiles were assessed, including hemoglobin (Hb), platelet count (PLT), serum albumin, total protein, serum testosterone, and various stigmata of chronic alcoholism. Results The spectrum of ALD revealed that fatty liver was present in 30.0% (n=45) of patients, alcoholic hepatitis in 20.0% (n=30), and cirrhosis in 50.0% (n=75). In the fatty liver group, 60.0% (n=27) had Grade 1 severity, 28.9% (n=13) had Grade 2, and 11.1% (n=5) had Grade 3. Biochemical parameters showed a marked decrease in Hb in cirrhosis (9.24 ± 2.93 g/dl) compared to fatty liver (11.97 ± 3.10 g/dl) and alcoholic hepatitis (11.10 ± 3.01 g/dl). PLT was lowest in cirrhosis (170,718.67 ± 124,250.94 cells/mm³), and serum albumin levels were significantly lower in cirrhosis (2.69 ± 0.67 g/dl). Total bilirubin levels were highest in alcoholic hepatitis (4.76 ± 2.80 mg/dl), while liver enzymes serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) were markedly elevated in alcoholic hepatitis (336.90 ± 156.10 and 232.60 ± 125.93 IU/L, respectively). Hormonal analysis indicated hyperestrogenemia in 57.8% (n=26) of fatty liver patients and 70% (n=21) of those with alcoholic hepatitis and cirrhosis (n=53). Hyperprolactinemia was observed in 62.7% (n=28) of fatty liver patients, 55.6% (n=17) of those with alcoholic hepatitis, and 53.3% (n=40) with cirrhosis. Decreased serum testosterone was most prominent in cirrhosis (57.3%, n=43). Conclusions Patients with ALD exhibit significant clinical and biochemical abnormalities across all stages. Gonadal hormone levels, particularly estrogen and testosterone, are notably altered and may not always correlate with disease severity. Elevated serum testosterone and sex hormone-binding globulin (SHBG) levels, alongside the presence of chronic alcoholism stigmata, are indicative of disease progression. The association of hyperestrogenemia with gynaecomastia and hypoandrogenemia with sparse pubic/axillary hair underscores the need for further research on hormonal markers in ALD.