Spironolactone hepatitis in primary hyperaldosteronism

Spironolactone-induced hepatitis

There is widespread use of spironolactone in medical practice and the indications for its use well established and side effect profile well known. Herein, we present a case of drug-induced hepatitis occurring in a 50-year-old woman using spironolactone for the treatment of androgenetic alopecia. Six weeks after commencement of spironolactone the patient became unwell, complained of an extensive itch, but no icterus or jaundice. Liver function tests found abnormally elevated bilirubin and enzymes levels. After withdrawal of spironolactone, the patient's symptoms resolved and liver function improved. To date, there has only been one other report of spironolactone-induced hepatitis.

Hepatic fibrin-ring granulomas in giant cell arteritis

Hepatic fibrin-ring granulomas were found in a 70-year-old man with prolonged fever and inflammatory syndrome. Diagnosis of giant cell arteritis was confirmed by temporal artery biopsy. Other diseases usually associated with fibrin-ring granulomas in liver, such as Q fever, cytomegalovirus hepatitis, infectious mononucleosis, Hodgkin's disease, non-Hodgkin's lymphoma, allopurinol treatment, and visceral leishmaniasis, were ruled out. This report suggests that giant cell arteritis should be considered as an additional cause of hepatic fibrin-ring granulomas.

Spironolactone: a re-examination

A review of the aldosterone antagonist spironolactone is presented. It is effective both as monotherapy and in combination with other hypotensive agents in the control of both essential and hyperaldosterone-induced hypertension. It is useful as a diuretic in conditions such as cirrhosis and congestive heart failure, and is most commonly employed because of its potassium- and magnesium-sparing qualities. Spironolactone also has been used as an antiandrogenic agent in managing hirsutism. Its adverse effect profile, considered somewhat prohibitive in the past, is generally not significant when reasonably low doses (less than 150 mg/d) are used.

Drug effects on the liver. An updated tabular compilation of drugs and drug-related hepatic diseases

Generic and chemical names of drugs and the possible adverse effects of these drugs on the human liver are tabulated. Most drugs compiled in these tables have been approved by the Federal Drug Administration. They are currently available in the United States, and they are listed in the 1983 Physicians' Desk Reference. Some important investigational drugs are listed also. The tables include: (1) generic names of drugs that have caused a characteristic morphologic change, such as granulomatous hepatitis; (2) morphologic diagnoses that have been documented after administration of each drug; and (3) references that can be matched to each drug and to its effects on the liver.

Drugs and liver disease: a tabular compilation of drugs and the histopathological changes that can occur in the liver

A compilation of drugs and the histopathological changes that can occur in the liver is presented. The purpose of this review is to provide the reader with a comprehensive and reliable source of information on various drugs that have been documented by liver biopsy to cause hepatocellular damage. The morphologic terms used in the tables have been chosen based on past publications dealing with this subject. This review is intended as a concise guide to aid in the identification of drug-induced liver diseases.