Abstract：
BACKGROUND: Mifepristone, also known as RU-486, is an anti-progestational steroid with similar chemical structure to anabolic steroids. Given as a single dose in conjunction with misoprostol, mifepristone is used to induce medical abortion. Mifepristone administered chronically at a higher dose is also approved for the management of hypercortisolism. There have been only 2 reported cases of mifepristone associated liver injury, in both cases, in the setting of Cushing syndrome. We report a third patient with Cushing syndrome with mifepristone induced liver injury with unique histological findings that provide insight to the pathophysiology of liver injury in mifepristone and anabolic steroids.
METHODS: Patient is a 63-year-old Caucasian female Cushing disease with no prior history of liver disease. She was started on mifepristone and semaglutide. Ninety days after initiating mifepristone, she developed deep jaundice, severe pruritus, fatigue, and nausea. Liver tests revealed a mixed hepatocellular/cholestatic pattern. Viral and autoimmune serologies were negative and there was no biliary dilatation on imaging. Liver biopsy showed severe cholestasis but no bile duct injury. Focal endothelialitis was present within a central venule. Cholestatic symptoms persisted for one month after presentation before slowly subsiding. Four months after stopping mifepristone, the patient\'s symptoms completely resolved, and liver tests became normal. Compilation of Roussell Uclaf Causality Assessment Method score indicated probable causality.
CONCLUSIONS: Mifepristone shares a similar chemical structure as synthetic anabolic/androgenic steroids and there are many similarities in the clinical presentation of liver injury. This case and the 2 other reported cases share similar clinical characteristics. The observation of endothelialitis in our patient may provide a mechanistic link between mifepristone, or anabolic steroids in general, and the development of vascular complications such as peliosis.
METHODS: Patient is a 63-year-old Caucasian female Cushing disease with no prior history of liver disease. She was started on mifepristone and semaglutide. Ninety days after initiating mifepristone, she developed deep jaundice, severe pruritus, fatigue, and nausea. Liver tests revealed a mixed hepatocellular/cholestatic pattern. Viral and autoimmune serologies were negative and there was no biliary dilatation on imaging. Liver biopsy showed severe cholestasis but no bile duct injury. Focal endothelialitis was present within a central venule. Cholestatic symptoms persisted for one month after presentation before slowly subsiding. Four months after stopping mifepristone, the patient\'s symptoms completely resolved, and liver tests became normal. Compilation of Roussell Uclaf Causality Assessment Method score indicated probable causality.
CONCLUSIONS: Mifepristone shares a similar chemical structure as synthetic anabolic/androgenic steroids and there are many similarities in the clinical presentation of liver injury. This case and the 2 other reported cases share similar clinical characteristics. The observation of endothelialitis in our patient may provide a mechanistic link between mifepristone, or anabolic steroids in general, and the development of vascular complications such as peliosis.
摘要：
背景：米非司酮，也称为RU-486，是一种与合成代谢类固醇具有相似化学结构的抗孕激素类固醇。作为单剂量与米索前列醇联合使用，米非司酮用于诱导药物流产。长期以较高剂量施用的米非司酮也被批准用于治疗皮质醇增多症。仅有2例米非司酮相关肝损伤的报道，在这两种情况下，在库欣综合征的背景下。我们报告了第三例米非司酮引起的库欣综合征患者肝损伤，其独特的组织学发现可深入了解米非司酮和合成代谢类固醇肝损伤的病理生理学。
方法：患者是一名63岁的白人女性库欣病，既往无肝病史。她开始服用米非司酮和司马鲁肽。开始使用米非司酮90天后，她出现了深黄疸,严重瘙痒,疲劳,和恶心。肝脏检查显示肝细胞/胆汁淤积混合模式。病毒和自身免疫性血清学均为阴性，影像学上无胆道扩张。肝活检显示严重胆汁淤积，但无胆管损伤。局灶性内膜炎存在于中央小静脉内。出现胆汁淤积症状后持续一个月，然后缓慢消退。停用米非司酮四个月后,病人的症状完全缓解，肝脏检查也正常了.RoussellUclaf因果关系评估方法评分的汇编表明可能的因果关系。
结论：米非司酮与合成合成合成代谢/雄激素类固醇具有相似的化学结构，并且在肝损伤的临床表现上有许多相似之处。该病例与其他2例报道的病例具有相似的临床特征。在我们的患者中观察到内皮炎可能提供了米非司酮之间的机械联系，或一般的合成代谢类固醇，和血管并发症的发展，如骨质疏松。
方法：患者是一名63岁的白人女性库欣病，既往无肝病史。她开始服用米非司酮和司马鲁肽。开始使用米非司酮90天后，她出现了深黄疸,严重瘙痒,疲劳,和恶心。肝脏检查显示肝细胞/胆汁淤积混合模式。病毒和自身免疫性血清学均为阴性，影像学上无胆道扩张。肝活检显示严重胆汁淤积，但无胆管损伤。局灶性内膜炎存在于中央小静脉内。出现胆汁淤积症状后持续一个月，然后缓慢消退。停用米非司酮四个月后,病人的症状完全缓解，肝脏检查也正常了.RoussellUclaf因果关系评估方法评分的汇编表明可能的因果关系。
结论：米非司酮与合成合成合成代谢/雄激素类固醇具有相似的化学结构，并且在肝损伤的临床表现上有许多相似之处。该病例与其他2例报道的病例具有相似的临床特征。在我们的患者中观察到内皮炎可能提供了米非司酮之间的机械联系，或一般的合成代谢类固醇，和血管并发症的发展，如骨质疏松。
