These liver tumors are frequently located on the hepatic lobes of the liver, more specifically the right hepatic lobe. 70-80% of all hepatic adenomas are found to be solitary, although there have been numerous cases where multiple adenomas were discovered.
Whether singular or multiple, hepatic adenomas can range in size anywhere from 1cm to 20cm. It is usually suggested that those tumors discovered to be 5cm or larger be resected to prevent further complications, including rupture.
Hepatic adenomas have large blood vessels located on their surfaces that may outgrow their required blood supply and ultimately rupture causing a dangerous hemorrhage. This risk of rupture seems to be solely related to the size in which the adenoma is, and does not seem related to the number of tumors.
MRIs are the most common form of detection of hepatic adenomas and are often found in patients undergoing imaging for unrelated symptoms. Ultrasounds, computed tomography, or magnetic resonance are other forms of imaging that may reveal the tumors on a patient’s liver.
When found to be present on a patient’s liver, it is important to distinguish a hepatic adenoma from other benign liver tumors because hepatic adenomas have a small risk of progressing into a malignancy and may require resection by a certified liver specialist.
Prolonged use of oral contraceptives have long been associated with the development of hepatic adenomas. However, having glycogen storage disease and the use of anabolic steroids have also been linked to these types of tumors.
Today we will take a look at all three of the common hepatic adenoma causes to help you determine if you might be at risk for developing a hepatic adenoma.
Common Risks for Hepatic Adenomas
Use of Contraceptives
Hepatic adenomas most commonly occur in women of childbearing age who use oral contraceptive pills and other hormonal therapies involving estrogen. This was strongly documented in the 1970s when there was a dramatic increase in the instances of hepatic adenomas starting from the time oral contraceptive pills were introduced to the market in the 1960s.
Before the introduction of oral contraceptive pills (OCPs), there were no reported hepatic adenomas in the Mayo Clinic from the years 1907-1954.
Moreover, the current annual incidence of reported hepatic adenomas for women having never used OCPs is 1 in 1.3 million, whereas that increases to 3.4 out of 100,000 for long term users of OCPs.
Worse still, the reports of hepatic adenomas increase 5-fold for those exposed to OCPs for 5-7 years, and 25-fold for those with exposure of 9 years or longer.
Today there is an estimated 320 cases of hepatic adenomas reported each year in the United States, 282 of which are attributed to oral contraceptive use.
It is worth mentioning that the higher the estrogen amount in the OCPs, as well as the length of use, play a large role in whether a woman will develop a hepatic adenoma in her lifetime. Conversely, as the estrogen amounts in OCPs have decreased over the years, being replaced by other just as effective hormones, the hepatic adenoma detection rate has reduced significantly as well.
It is important that your physician be aware of the adverse effects OCPs are capable of causing, specifically when it comes to hepatic adenomas. Though this is a rare occurrence, patients using OCPs can develop this complication after any length of use. Discussing this possibility with your physician is essential so that you may make the best choice for your health when it comes to your contraception choices.
Glycogen Storage Disease
Those with glycogen storage disease (GSD) have an increased chance of developing a hepatic adenoma in their lifetime. In fact, GSD has been associated with patients who exhibit multiple hepatic adenomas at one time on their livers increasing the risk of rupture or malignancy transformation.
Occurring more commonly in men than women (at a ratio of 2:1), these hepatic adenomas usually develop before the patient is 20 years of age. Insulin and glycogen imbalances seem to be the hepatic adenoma causes, which is the foundation to GSD.
Glycogen Storage Disease is an inherited metabolic disorder whereby the body has trouble breaking down certain foods and creating energy from it. Caused by an enzyme deficiency, this disorder is a genetic disease affecting several thousand people in the United States alone.
Excess glucose from the foods ingested are normally stored in a person’s body as glycogen and is released into the blood stream when energy is needed.
When certain required enzymes are missing to complete this process, the liver cannot properly release the stored glycogen causing an excess amount to build up. It is suggested that this imbalance, as noted before, is a contributing factor to hepatic adenomas.
Luckily, it has been noted that with dietary management the risk of forming a hepatic adenoma is significantly decreased in those with GSD.
If you or someone you know has glycogen storage disorder and are concerned about the development of hepatic adenomas, contact your liver specialist physician right away to determine you risk and proper health management options.
Another hepatic adenoma cause is the prolonged use of anabolic steroids. The abuse of anabolic steroids, mostly commonly seen amongst athletes, comes with a number of health complications.
First marketed to the public in the 1930s, steroids are now used responsibly in the medical field as a therapeutic medicine used to stimulate muscle growth and appetite, induce male puberty, and treat chronic wasting conditions such as cancer and AIDS.
According to the American College of Sports Medicine, when used appropriately and with an adequate diet, steroids can be useful for increasing body weight and even muscle growth.
Looked at as an unfair advantage in the field of sports however, steroids in the United States are currently listed as a Schedule III controlled substance under the Controlled Substances Act, making the simple possession of steroids without a prescription a federal crime.
With excessive steroid use, there are a number of reports that hepatic adenomas not only form, but have a higher chance of rupture as well.
Steroids are metabolized in the digestive system to increase their bioavailablity and stability. Due to this absorption method, with an increased dosage of steroids comes an increased risk of developing a hepatic adenoma as well as other liver damage complications.
Despite the legal ramifications for possession and/or use of steroids, many people can and do easily obtain these drugs via the internet. Although the benefits of using such a drug as steroids may initially seem to outweigh any potential consequences, it is important that anyone abusing steroid be made aware of the medical risks associated with such use.
In the end, there are several ways in which a person may become vulnerable to the formation of a hepatic adenoma.
Whether through the prolonged use of oral contraceptives or anabolic steroids, or to the unfortunate case of having an inherited metabolic disease such as glycogen storage disease, hepatic adenoma symptoms can potentially surface and cause harm to your overall health, despite its benign nature.
If you think you may be at risk for developing a hepatic adenoma, consider consulting with Dr. Mark Fraiman and his team of liver specialists.
With years of experience and a great track record of positive results, he will be able to help you develop a treatment plan specialized for you so that you remain healthy and free from worry about the development of a hepatic adenoma.