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Gonadal dysfunction in male patients with Budd Chiari syndrome and its reversibility with treatment

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Abstract

Background and aims

Budd Chiari syndrome (BCS) commonly affects adolescents and adults. With improved survival, important quality-of-life parameters such as sexual life and fertility become more relevant. This study was aimed to assess the gonadal function in male patients with BCS and the effect of treatment on gonadal function.

Methods

Thirty male patients with newly diagnosed BCS were prospectively assessed for the presence of gonadal dysfunction. Erectile function was assessed using standardized International Index of Erectile Function questionnaire (IIEF). Follicular stimulating hormone (FSH), luteinizing hormone (LH), sex hormone-binding globulin (SHBG), estradiol, total testosterone (TT), calculated free testosterone (cFT), calculated bioavailable testosterone (cBT), sperm count, and sperm motility were compared at baseline and at 6 months of treatment for the assessment of gonadal function.

Results

Sixteen (53.3%) out of 30 patients were sexually active at the time of study and 5/16 (31%) had erectile dysfunction. Hypogonadotropic hypogonadism (HH) was the most common pattern seen in 50% cases followed by hypergonadotropic hypogonadism (HyH) in 23% cases. 27% patients had eugonadism. At 6 months of treatment, 60% of patients in HH group became eugonadal as compared to only 14% in HyH group. Proportion of patients with erectile dysfunction reduced (5/16 vs 1/16) after 6 months of therapy. The improvement in sperm count and sperm motility was not significant.

Conclusion

Gonadal dysfunction is common in male patients with BCS. HH remains the most common type of hypogonadism BCS and the type which improves significantly after treatment.

Graphical abstract

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Data transparency

All data and materials as well as software application or custom code support their published claims and comply with field standards.

Data availability

Datasets generated and analyzed during the current study are available from the corresponding author on request.

Code availability (software application or custom code)

Not applicable.Not applicable.

Plant reproducibility

Current article does not contain any research related to plants; hence, this part is not applicable to current article.

Abbreviations

LH:

Luteinizing hormone

SHBG:

Sex hormone-binding globulin

BCS:

Budd Chiari syndrome

IIEF:

International index of erectile function

FSH:

Follicular stimulating hormone

cFT:

Calculated free testosterone

cBT:

Calculated bioavailable testosterone

CTP:

Child–Turcotte–Pugh

MELD:

Model for end-stage liver disease

HH:

Hypogonadotropic hypogonadism

HyH:

Hypergonadotropic hypogonadism

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Acknowledgements

The authors would like to thank Dr. Dinesh Uchil and Dr. Varsha Kale for their kind support at MRU Laboratory.

Funding

The study was funded by the Multidisciplinary Research Unit (MRU), Seth GSMC & KEM Hospital, Department of Health research, Govt. of India.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, 400012, India

    Nitin Ramani, Kashmira Kawli, Abhijeet Karad, Aditya Kale, Vinit Kahalekar, Sridhar Sundaram, Shobna Bhatia & Akash Shukla

  2. Department of Endocrinology, Seth G S Medical College and KEM Hospital, Mumbai, India

    Ravikumar Shah & Tushar Bandgar

  3. Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, India

    Hemant Deshmukh

  4. Department of Urology, Seth G S Medical College and KEM Hospital, Mumbai, India

    Sujata Patwardhan

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  1. Nitin Ramani
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Contributions

Concept and design: AS and HD; consent and recruitment of participants: NR, VK, and AK; collection of blood samples and laboratory work: KK; data curation: NR and KK; data analysis and interpretation: NR, AK (Aditya Kale), SS, and AS; original manuscript: NR and KK; review and editing of manuscript: AS, SS, RS, TB, HD, and SP; supervision: SB, SS, and AS.

Corresponding author

Correspondence to Akash Shukla.

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Conflict of interest

Nitin Ramani, Kashmira Kawli, Abhijeet Karad, Aditya Kale, Vinit Kahalekar, Sridhar Sundaram, Shobna Bhatia, Ravikumar Shah, Tushar Bandgar, Hemant Deshmukh, Sujata Patwardhan, and Akash Shukla declare that we have no conflict of interest.

Consent to participate (include appropriate statements)

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Animal studies

This article does not contain any studies with animal subjects.

Ethical approval

Ethics committee approval was obtained. Letter reference no-EC/OA-55/2016.

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The work has not been published before (except in the form of an abstract or as part of a published lecture, review or thesis). The work is not under consideration elsewhere. Copyright has not been breached in seeking its publication. The publication has been approved by all co-authors and responsible authorities at the institute or organization where the work has been carried out.

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Ramani, N., Kawli, K., Karad, A. et al. Gonadal dysfunction in male patients with Budd Chiari syndrome and its reversibility with treatment. Hepatol Int 16, 640–648 (2022). https://doi.org/10.1007/s12072-022-10316-9

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  • DOI: https://doi.org/10.1007/s12072-022-10316-9

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