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A 25-year-old woman with type 2 diabetes and liver disease.

Junker AE, Gluud LL, Pedersen J, Langhoff JL, Holst JJ, Knop FK, Vilsbøll T - Case Rep Gastroenterol (2014)

Bottom Line: Repeat liver biopsy and ultrasound showed reduction in hepatic fat content and inflammatory cells.The liver biopsies did not express hepatic GLP-1Rs using quantitative polymerase chain reaction.Our case suggests that liraglutide may benefit patients with NASH.

View Article: PubMed Central - PubMed

Affiliation: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark ; NNF Center for Basic Metabolic Research and Department of Biomedical Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

ABSTRACT
A 25-year-old female nurse was referred to our diabetes outpatient clinic with poorly controlled type 2 diabetes, obesity and elevated liver function tests (LFTs). Following a liver biopsy she was diagnosed with non-alcoholic steatohepatitis (NASH) and liver fibrosis. Treatment with subcutaneous injections of the glucagon-like peptide-1 receptor (GLP-1R) agonist liraglutide was initiated. After 46 weeks of treatment the patient had lost 16 kg, glycemic control was excellent and LFTs had normalized. Repeat liver biopsy and ultrasound showed reduction in hepatic fat content and inflammatory cells. The biopsy no longer fulfilled the criteria for NASH. The liver biopsies did not express hepatic GLP-1Rs using quantitative polymerase chain reaction. Our case suggests that liraglutide may benefit patients with NASH.

No MeSH data available.


Related in: MedlinePlus

a Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including >66% of hepatocytes, ballooning cells and lobular inflammation (NAFLD activity score 5) consistent with NASH. Pericellular and periportal fibrosis (fibrosis score 2). b Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including 40–50% of hepatocytes, sparse lobular inflammation and no ballooning cells (NAFLD activity score 2) consistent with simple steatosis. Pericellular and periportal fibrosis (fibrosis score 2).
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Figure 1: a Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including >66% of hepatocytes, ballooning cells and lobular inflammation (NAFLD activity score 5) consistent with NASH. Pericellular and periportal fibrosis (fibrosis score 2). b Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including 40–50% of hepatocytes, sparse lobular inflammation and no ballooning cells (NAFLD activity score 2) consistent with simple steatosis. Pericellular and periportal fibrosis (fibrosis score 2).

Mentions: After 8 weeks on metformin and insulin, HbA1c had markedly improved to 6.3%, but LFTs except for ALP remained elevated (ALT 133 U/l, AST 76 U/l, ALP 69 U/l). The patient was then scheduled for a liver biopsy, which showed hepatic fat infiltration involving more than 66% of hepatocytes, ballooned hepatocytes, lobular inflammation as well as pericellular and periportal fibrosis. The histological diagnosis was NASH with a NAFLD activity score of 5 (score range 0–8) and a fibrosis score of 2 (score range 0–4) (fig. 1a). Treatment with subcutaneous injections of the GLP-1R agonist liraglutide was initiated. The initial dose was 0.6 mg once daily subcutaneously. The dose was increased with weekly increments of 0.6–1.8 mg once daily during the following weeks. Liraglutide was well tolerated with no side effects such as nausea or vomiting. Insulin was gradually reduced and discontinued after 7 weeks.


A 25-year-old woman with type 2 diabetes and liver disease.

Junker AE, Gluud LL, Pedersen J, Langhoff JL, Holst JJ, Knop FK, Vilsbøll T - Case Rep Gastroenterol (2014)

a Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including >66% of hepatocytes, ballooning cells and lobular inflammation (NAFLD activity score 5) consistent with NASH. Pericellular and periportal fibrosis (fibrosis score 2). b Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including 40–50% of hepatocytes, sparse lobular inflammation and no ballooning cells (NAFLD activity score 2) consistent with simple steatosis. Pericellular and periportal fibrosis (fibrosis score 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296242&req=5

Figure 1: a Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including >66% of hepatocytes, ballooning cells and lobular inflammation (NAFLD activity score 5) consistent with NASH. Pericellular and periportal fibrosis (fibrosis score 2). b Microscopic view of liver tissue (hematoxylin-eosin, ×100). Liver tissue with hepatic fat infiltration including 40–50% of hepatocytes, sparse lobular inflammation and no ballooning cells (NAFLD activity score 2) consistent with simple steatosis. Pericellular and periportal fibrosis (fibrosis score 2).
Mentions: After 8 weeks on metformin and insulin, HbA1c had markedly improved to 6.3%, but LFTs except for ALP remained elevated (ALT 133 U/l, AST 76 U/l, ALP 69 U/l). The patient was then scheduled for a liver biopsy, which showed hepatic fat infiltration involving more than 66% of hepatocytes, ballooned hepatocytes, lobular inflammation as well as pericellular and periportal fibrosis. The histological diagnosis was NASH with a NAFLD activity score of 5 (score range 0–8) and a fibrosis score of 2 (score range 0–4) (fig. 1a). Treatment with subcutaneous injections of the GLP-1R agonist liraglutide was initiated. The initial dose was 0.6 mg once daily subcutaneously. The dose was increased with weekly increments of 0.6–1.8 mg once daily during the following weeks. Liraglutide was well tolerated with no side effects such as nausea or vomiting. Insulin was gradually reduced and discontinued after 7 weeks.

Bottom Line: Repeat liver biopsy and ultrasound showed reduction in hepatic fat content and inflammatory cells.The liver biopsies did not express hepatic GLP-1Rs using quantitative polymerase chain reaction.Our case suggests that liraglutide may benefit patients with NASH.

View Article: PubMed Central - PubMed

Affiliation: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark ; NNF Center for Basic Metabolic Research and Department of Biomedical Science, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

ABSTRACT
A 25-year-old female nurse was referred to our diabetes outpatient clinic with poorly controlled type 2 diabetes, obesity and elevated liver function tests (LFTs). Following a liver biopsy she was diagnosed with non-alcoholic steatohepatitis (NASH) and liver fibrosis. Treatment with subcutaneous injections of the glucagon-like peptide-1 receptor (GLP-1R) agonist liraglutide was initiated. After 46 weeks of treatment the patient had lost 16 kg, glycemic control was excellent and LFTs had normalized. Repeat liver biopsy and ultrasound showed reduction in hepatic fat content and inflammatory cells. The biopsy no longer fulfilled the criteria for NASH. The liver biopsies did not express hepatic GLP-1Rs using quantitative polymerase chain reaction. Our case suggests that liraglutide may benefit patients with NASH.

No MeSH data available.


Related in: MedlinePlus