Androgens peliosis

Hepatotoxicity Prolonged use of high doses of androgens has been associated with the development of potentially life-threatening peliosis hepatis, hepatic neoplasms, and hepatocellular carcinoma. Cholestatic hepatitis and jaundice occur with fluoxymesterone and methyltestosterone at relatively low doses. Drug-induced jaundice is reversible when the medication is discontinued. 

The causes of peliosis hepatis are varied and include anabolic or androgenic steroids, oestrogens (52), azathio-prine, arsenic, vinyl chloride, tamoxifen and danazol as well as tuberculosis, histiocytosis, leishmaniasis, leprosy, carcinoma, sprue, liver abscess, cytomegalovirus infection, glycogenosis (type I) (14) and marasmus. (46) Congenital (angiomatous) abnormality of the vessels may also be a contributory factor. (5) The respective development of peliosis hepatis is still unclear. 

Medicinal agents (such as contraceptives) may result in proliferations of the intima in the hepatic artery and its branches. In some cases, these arterial alterations were associated with thrombosis in the hepatic veins. Phar-macons can trigger three different forms of damage to the sinusoids (7.) dilation of the sinusoids (e.g. by contraceptives), (2.) perisinusoidal fibrosis (e.g. by azathio-prine, vitamin A and cytostatic agents), and (i.) peliosis hepatis (e. g. by contraceptives, anabolic and androgenic steroids, azathioprine, chenodesoxycholic acid). (13, 28, 130) (s. p. 398) (s. fig. 21.8)... 

The principal side effects of the 17a-alkylated androgens are hepatic, including cholestasis, and uncommonly, peliosis hepatis (blood-filled hepatic cysts). Hepatocellular cancer has rarely been reported. When administered at high doses, these androgens are more likely than others to affect serum lipid concentrations, specifically to decrease high-density lipoprotein cholesterol and increase low-density lipoprotein cholesterol. 

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