Endocrine Abstracts

JOINT3874

Background: Semaglutide, a GLP-1 receptor agonist, is widely used for weight management and has been associated with improvements in liver enzymes and hepatic steatosis. Reports of hepatotoxicity are rare.¹.

Case Presentation: A 42-year-old female with a history of obstructive sleep apnea and sleep-related eating disorder presented for weight management. She had been on semaglutide for two years, achieving a 40-pound weight loss. In December 2023, she contracted COVID-19, followed by multiple infections treated with consecutive courses of antibiotics. In April 2024, she reported fatigue and malaise; laboratory tests revealed elevated liver enzymes (AST 222 U/l, ALT 333 U/L). Semaglutide and amoxicillin were discontinued, but liver enzymes further increased (AST 600 U/l, ALT 342 U/l)before gradually declining. Subsequent use of Bactrim led to a transient rise in liver enzymes.

Discussion: The temporal association between semaglutide discontinuation and the rise in liver enzymes suggests a potential link. However, the concurrent use of multiple antibiotics and recent infections complicate the attribution of hepatotoxicity solely to semaglutide. Notably, semaglutide has been associated with liver enzyme reductions in patients with obesity and type 2 diabetes, and recent studies have indicated its potential benefits in improving liver fibrosis in patients with metabolic dysfunction-associated steatohepatitis.².

Conclusion: This case underscores the importance of monitoring liver function in patients receiving semaglutide, especially those with complex medical histories and concurrent medication use. Further research is warranted to elucidate the hepatic effects of semaglutide and its safety profile in patients with predisposing factors for liver dysfunction.

References: 1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Semaglutide. [Updated 2019 Apr 10].

2. Newsome P, Francque S, Harrison S, Ratziu V, Van Gaal L, Calanna S, Hansen M, Linder M, Sanyal A. Effect of semaglutide on liver enzymes and markers of inflammation in subjects with type 2 diabetes and/or obesity. Aliment Pharmacol Ther. 2019 Jul;50(2):193-203. doi: 10.1111/apt.15316. Epub 2019 Jun 10.

Keywords: Semaglutide, Liver enzyme elevation, Obesity, Sleep-related eating disorder, Drug-induced liver injury, GLP-1 receptor agonist, Weight management, Antibiotic-associated hepatotoxicity.