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Cirrhosis Endocrine Complications — RACP Adult Medicine MCQ

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EasyGeneral Internal MedicineCirrhosis Endocrine ComplicationsRACP Adult Medicine

A 68-year-old man presents with bilateral gynaecomastia and testicular atrophy. He has spider naevi and palmar erythema. His liver function tests show elevated bilirubin and low albumin. Ultrasound shows a cirrhotic liver. What is the mechanism of gynaecomastia in cirrhosis?

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Correct answer: C — Impaired hepatic oestrogen metabolism

In cirrhosis, the liver fails to adequately metabolise oestrogens, leading to a relative hyperoestrogenaemic state. Additionally, there is increased sex hormone-binding globulin (SHBG) which binds testosterone preferentially, further increasing the oestrogen-to-androgen ratio. This causes gynaecomastia, spider naevi, palmar erythema, and testicular atrophy. Alcohol itself also has direct toxic effects on the testes.

Reference: eTG – 2025 – Gastrointestinal; Sherlock's Diseases of the Liver – 2018