Statins may increase the risk of liver dysfunction in patients treated with steroids for active graves' orbitopathy

The Journal of Clinical Endocrinology and Metabolism
Danila CovelliMario Salvi

Abstract

Intravenous glucocorticoids (IVGC) administered at high doses for the treatment of active moderate-severe Graves' orbitopathy (GO) may induce liver toxicity. Cumulative doses should not exceed 8 g and strict monitoring of liver function is recommended to avoid potentially life-threatening side effects. The 3-hydroxy-3-methylglutaryl-coenzyme reductase inhibitors, also known as statins, are employed to prevent major cardiovascular events. Patients with active GO, requiring immunosuppression with IVGC, are often treated with statins also. We studied a 64-year-old man and a 58-year-old woman who developed significant liver toxicity after moderate doses of IVGC (methylprednisolone 2.3 g and 5 g in patients 1 and 2, respectively) and concomitant administration of statins. Liver function tests were monitored every two weeks. Hepatitis virus markers and serology for autoimmune hepatitis were negative. At the occurrence of liver dysfunction (5-fold increase of serum aspartate aminotransferase/alanine aminotransferase concentrations), in patient 1 we stopped simvastatin indefinitely and discontinued IVGC for 2 weeks, whereas in patient 2, ongoing treatment with rosuvastatin was discontinued 3 weeks after IVGC therapy. In patient 1, off ...Continue Reading

Citations

Mar 12, 2016·Expert Review of Clinical Pharmacology·Marek Ruchała, Nadia Sawicka-Gutaj
Apr 2, 2016·European Journal of Endocrinology·Irene CampiMario Salvi
Jan 11, 2020·International Ophthalmology·Jessica M Pouso-DizFrancisco Gonzalez
Jun 21, 2018·Journal of Endocrinological Investigation·G LanzollaM Marinò
Mar 18, 2016·Clinical and Experimental Dental Research·Xianqi LiHideaki Kagami
May 12, 2019·International Journal of Environmental Research and Public Health·Liang-Tsai YehChi-Ho Chan
Jan 1, 2020·Thyroid Research·Dorota Walasik-SzemplińskaIwona Sudoł-Szopińska

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