Decompensated liver cirrhosis as a rare consequence of long-term untreated panhypopituitarism after craniopharyngioma resection: a case report

Background: Panhypopituitarism is a common complication following craniopharyngioma surgery, and it is a known risk factor for metabolic disturbances, including non-alcoholic fatty liver disease (NAFLD). However, the progression from NAFLD to end-stage, decompensated liver cirrhosis in this context is exceptionally rare and seldom reported. Case presentation: We report the case of a 36-year-old male who presented with decompensated liver cirrhosis (ascites and portal hypertension) 13 years after resection of a craniopharyngioma. He had received no regular hormone replacement therapy for more than a decade. Notably, he had no postoperative hyperphagia, his body mass index was 21.1 kg/m2, and both fasting venous glucose (4.11 mmol/L) and glycated hemoglobin (4.7%) were normal. The workup for common etiologies of cirrhosis was negative, including viral hepatitis and the available autoimmune serologies. Endocrine evaluation confirmed severe panhypopituitarism, including central adrenal insufficiency, central hypothyroidism, central hypogonadism, and severe growth hormone deficiency (IGF-1 Z-score -2.7). Upper gastrointestinal endoscopy documented esophagogastric varices, and liver biopsy confirmed established cirrhosis with mild hepatocellular steatosis, supporting NAFLD as the most plausible underlying pathway. The patient was initiated on comprehensive hormone replacement (including hydrocortisone, levothyroxine, testosterone, and GH) and supportive care, with complete resolution of ascites at the 2-month follow-up. Conclusions: This case demonstrates that end-stage liver disease can be a severe, albeit rare, consequence of long-term, untreated panhypopituitarism. We conclude that severe GH deficiency, acting in synergy with other hormonal deficits, likely served as the critical driver for NAFLD progression to cirrhosis. This report underscores the necessity of comprehensive, lifelong endocrine management and metabolic monitoring for craniopharyngioma survivors to prevent irreversible organ damage.