Growth hormone cocktail improves hepatopulmonary syndrome secondary to hypopituitarism: A case report

Figure 1 Imaging examination on admission. A: Magnetic resonance imaging of the Sellar region. Orange circle shows the hallmarks of pituitary stalk interruption syndrome, including invisible pituitary stalk, and hypoplastic anterior pituitary gland combined with disappeared hyperintense signal in the posterior pituitary; B: Clubbed fingers; C: Prominent gastric varices under gastroscopy; D: Ultrasonic examination of the liver: Coarse texture with an oblique diameter of 16.6 cm and more echo compared to the right renal cortex, in keeping with liver cirrhosis and diffuse fatty liver; E: Enlarged spleen (15.9 cm × 4.4 cm); F: Transthoracic contrast echocardiography showed opacification in the left chamber of the heart by micro-bubbles five heartbeats after the appearance of microbubbles in the right atrium (orange circle).

Figure 2 Response to hormone treatment. A: Uptake ratio of radionuclides ^99mTc macroaggregated albumin of the whole body. Intrapulmonary shunting returned to normal (bottom) from 64.4% (top). These images are from department of nuclear medicine, Peking Union Medical College Hospital; B: The right Y-axis represents fibrosis 4 (FIB-4) index, and the left Y-axis represents the intrapulmonary shunt ratio in percentage items, with PO₂ and SaO₂ in mmHg units. The PO₂ and SaO₂ levels markedly increased along with declination of intrapulmonary shunt ratio and FIB-4 index. FIB-4: Fibrosis 4.