Liver cirrhosis male sexual dysfunction syndrome, also known as endocrine deficiency-liver cirrhosis syndrome or Silvestrini-Corda syndrome. Its main clinical features include the development of gynecomastia, testicular atrophy, and sexual dysfunction in males with underlying liver cirrhosis. This syndrome is relatively common and occurs far more frequently in males than in females.

bubble_chart Pathogenesis

In cirrhosis, the decreased ability to inactivate estrogen and the increased conversion of androgens to estrogen lead to elevated blood estrogen levels and increased urinary excretion. The rise in estrogen levels can inhibit the hypothalamic-pituitary-gonadal axis through feedback mechanisms, resulting in reduced secretion of gonadotropins and adrenocorticotropic hormone, decreased androgen production, and consequently, feminization in males.

bubble_chart Clinical Manifestations

It manifests as gradual enlargement of male breasts, which can be unilateral or bilateral, with the right side being more common. At grade I, there is nodular protrusion of the nipple or areola, and in severe cases, it resembles female breasts, possibly accompanied by distending pain but no milk secretion. Additionally, there may be testicular atrophy, sparse pubic hair, decreased libido, and a finer voice, often accompanied by spider angiomas and palmar erythema caused by skin capillary dilation. In female patients, the manifestations of elevated estrogen are often less obvious, possibly including menstrual disorders, amenorrhea, infertility, and functional uterine bleeding.

bubble_chart Diagnosis

The measurement shows increased levels of E₂ and E₃ in the serum, along with decreased testosterone and its metabolites. The diagnosis can be made based on the presence of hypogonadism manifestations, such as gynecomastia in males, occurring on the basis of liver cirrhosis.

The treatment of this disease primarily focuses on the management of liver conditions. As the primary disease alleviates and liver function improves, male gonadal function may gradually recover. Some reports also suggest that androgen therapy may have certain therapeutic effects.