Successful GH Treatment of Hepatopulmonary Syndrome in Panhypopituitarism-related Advanced Liver Disease

Hepatopulmonary syndrome (HPS) is a known pulmonary vascular complication of chronic liver disease. In rare circumstances, HPS has been described in the context of panhypopituitarism. An underlying mechanism of panhypopituitarism-related liver injury is thought to stem from GH deficiency, leading to steatohepatitis from augmented lipid deposition within hepatocytes. Although liver transplantation remains the definitive treatment for HPS, resolution of panhypopituitarism-related HPS following GH replacement therapy has been occasionally described. These successful cases uniformly showed hepatic steatosis on biopsy that resolved after GH replacement, suggesting GH may effectively reverse the pathological process before permanent damage occurs. We present the first reported case of panhypopituitarism-related HPS successfully treated with GH replacement in the presence of significant liver fibrosis without steatosis. This case highlights the sustained therapeutic efficacy of GH even in advanced liver disease and adds to the limited literature regarding successful treatment of HPS, especially in the context of panhypopituitarism, without liver transplantation.