Tamoxifen-induced reversible hepatic steatosis

Last revised by Daniel J Bell on 27 Apr 2020

Tamoxifen is an important anti-estrogen agent used for the treatment of hormone receptor-positive breast cancer and it may induce reversible hepatic steatosis. This is usually transient and may occasionally be associated with hepatic dysfunction. It only rarely leads to cirrhosis 1.

45% of the patients having adjuvant tamoxifen develop hepatic steatosis in the first two years. The steatosis is usually mild in severity.

The mechanism by which tamoxifen causes hepatic steatosis is not fully understood. In vivo research shows that the drug disrupts plasma and liver lipid metabolism 3

The distribution of fat in the liver in this entity is right-lobe dominant. This may be due to the higher content of medium-chain fatty acids and glucose and the absorbed content of tamoxifen in the superior mesenteric venous blood, which is directed predominantly towards the right lobe (streamline flow) 2

The mean time for the tamoxifen-induced hepatic steatosis to resolve after therapy has ended is 12-18 months. Rarely the steatosis progresses to overt cirrhosis.

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