[Liver toxicity of androgen therapy in aplastic anemia]

In a prospective group study, 254 cases of aplastic anemia treated with a high dose of androgens were followed a minimum of 4 months and up to 8 years. Damage to the liver was evaluated by the appearance of jaundice or abnormal liver function tests; these parameters were evaluated at least every 3 months. Of these patients, 17.3% had overt jaundice and 18.2% abnormal hepatic function tets (total 35.5%). The anomalies appeared rapidly, before month 4 for 50% of the patients and before month 10 for 80%. They were more frequent in men than in women or children, but not linked with previous biological abnormalities. Nor did frequency depend on whether C17 methyl androgen or C17 ethyl androgen was used. Associated corticosteroids offered no protection. None of the patients showed severe jaundice or cirrhosis. If the treatment was stopped, readministration led to relapse of the jaundice in only one-third of the cases. Only two patients in this series revealed a nonmalignant tumor of the liver. Therefore, this complication does not seem to suggest restriction in the use of androgens at high dosage and for long periods, considering the severity of aplastic anemia.