PMC6047999_01
Chest X ray and CT. No abnormalities were found in the lung field or heart.
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Chest X-ray and computed tomography (CT) showed clear lung fields (Fig. 1).
Abdominal CT. Splenomegaly and atrophy of the left lobe were observed.
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Splenomegaly and atrophy of the left lobe were observed on an abdominal CT scan (Fig. 2).
Liver biopsy. First biopsy (A) (B) showed steatohepatitis, which was classified as stage 3-4; grade 1 according to Brunt's classification. The arrow indicates expanded fibrosis. The triangle indicates steatosis. After 6 months, a second biopsy was performed (C) (D). The fibrosis stage was found to have decreased to stage 2-3, and the steatosis and ballooning hepatocytes were diminished. (A) and (C), Mallory Azan staining. (B) and (D), Hematoxylin and Eosin staining.
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Brunt's classification (Fig. 3A and B). Based on these data, the patient was diagnosed with NASH associated with hypopituitarism combined with HPS. NASH (stage 2-3). No steatosis or ballooning hepatocytes were observed (Fig. 3C and D).
The clinical course. Growth hormone, testosterone, thyroid hormone and corticosteroid replacement therapy were re-started. The serum AST and ALT levels gradually decreased, and the platelet count increased to 16-20x104/muL.
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Growth hormone (somatropin, 5 mg), testosterone (testosterone enanthate, 62.5 mg/month), thyroid hormone (levothyroxine Sodium Hydrate, 100 mug/day) and corticosteroid (hydrocortisone, 15 mg/day) replacement therapy were re-started (Fig. 4). AST and ALT levels gradually decreased, and the platelet count increased to 16-20x104/muL (Fig. 4). A second liver biopsy performed at 5 months after re-starting hormone therapy showed the amelioration of