BERKELEY, CA (UroToday.com) - Cyproterone acetate (CPA) is an oral anti-androgen commonly used to treat advanced prostate cancer. Hepatotoxicity is a serious adverse reaction, potentially common to both steroidal and non-steroidal anti-androgens. A variety of hepatotoxic reactions have been reported, including immunoallergic cytotoxic reactions, cholestasis, acute hepatitis, fulminant hepatic failure, and cirrhosis. In addition, isolated cases of hepatocellular carcinoma associated with the use of CPA have been described. The mechanism involved in liver, by CPA, remains unclear. Thus we have reported a case of a 66-year-old patient who developed severe drug-induced hepatotoxicity during treatment by CPA.
The diagnosis of drug-induced hepatotoxicity is usually based on exclusion of other possible causes of hepatic dysfunction and on the temporal association between drug administration and the onset of liver disease. CPA is used in a variety of conditions where anti-androgenic effects are beneficial. Recommended dose is between 2 mg and 300 mg daily. The currently data available in literature suggest that adverse hepatic effects may occur more commonly in elderly patients with malignant disease who are treated with prolonged high doses of CPA. Our patient diagnosis of hepatotoxicity by CPA appeared to be related to temporal relationship of drug administration, negative tests for acute viral infections, negative auto-antibodies, and exclusion of other toxic agents. However, in the absence of the rechallenge for ethical reasons, proof is not possible. In most cases of drug-induced liver injury, the pathogenetic mechanism of anti-androgen-induced liver disease remains unknown. A direct hepatotoxicity CPA, mediated by an idiosyncratic mechanism, has been hypothesized by some authors. The role of CPA has been established on the following facts: 1) the patient had previously normal transaminase activity and no sign of chronic liver disease; 2) clinical liver injury occurred two months after CPA administration; 3) the patient did not receive new drugs or drugs suspected of hepatotoxicity during the same period.
Our case report illustrates the role of CPA as a drug responsible for severe subacute hepatitis, finds that the course of the disease is not rapidly interrupted by drug withdrawal, and suggests the benefit of corticosteroids as a treatment for the severe cases.
Written by:
Ludovico Abenavoli, MD, MSc, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Assistant Professor
Department of Health Sciences
University Magna Graecia, Campus Germaneto
Viale Europa, 88100 Catanzaro, Italy
Severe hepatitis induced by cyproterone acetate: Role of corticosteroids. A case report - Abstract
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