Adverse effects of hormones and hormone antagonists on the liver

Hepatotoxicity is well recognized with hormonal agents and their corresponding antagonists. The spectrum of liver diseases associated with contraceptive steroids and anabolic androgenic steroids ranges from acute hepatitis, cholestasis, and hepatic vascular toxicity through to benign and malignant liver tumors. Anabolic androgenic steroid-induced hepatic adenomas and hepatocellular carcinomas remain a concern with their continuing use both for prescriptional (Fanconi anemia) and nonprescriptional indications (e.g., bodybuilders). Tamoxifen-induced fatty liver disease is observed in over 40% of recipients, usually within the first 2 years of use and mostly in patients with the metabolic syndrome (commonly associated with breast cancer). Direct mitochondrial effects and perturbations of lipid metabolism by tamoxifen probably contribute to hepatic steatosis. Serious liver injury resulting from androgen blockade is best described with flutamide and cyproterone, but the newer agents (bicalutamide and nilutamide) can also cause hepatotoxicity. Of the antithyroid drugs, propylthiouracil has attracted recent scrutiny for its hepatotoxic potential in children and is no longer recommended as a first-line drug in this age group. In adults, carbimazole is a rarer cause of drug-induced hepatitis than is propylthiouracil.