SHM Converge Scientific Abstract ePoster Gallery-Emerging Hepatotoxicity Risk of Compounded GLP-1/Gip Ra's: A Case Report

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This case report describes a 57-year-old woman who developed severe liver injury after 5 weeks of compounded tirzepatide, a GLP-1/GIP receptor agonist used for weight loss. She initially presented with markedly elevated liver enzymes, jaundice, and impaired coagulation, while testing for viral, genetic, malignant, and most autoimmune causes was negative. Imaging suggested underlying chronic liver disease, but the overall evaluation raised concern for drug-induced liver injury (DILI).<br /><br />After tirzepatide was stopped, her transaminases temporarily improved, but cholestasis and coagulopathy worsened. Liver biopsy showed nonspecific changes favoring DILI, though autoimmune hepatitis could not be fully excluded. She was discharged after partial stabilization but returned two days later with worsening jaundice, nausea, vomiting, and acute liver failure. Steroids were started for possible autoimmune hepatitis, but her condition continued to deteriorate, and she developed encephalopathy. She was urgently listed for transplant and underwent successful orthotopic liver transplantation within 36 hours.<br /><br />Explant pathology showed chronic inflammation, lymphocytic infiltrates, plasma cells, bile ductular proliferation, centrilobular necrosis, and bridging fibrosis, consistent with progressive liver injury. The authors emphasize that hepatotoxicity is a rare but serious and possibly underrecognized complication of GLP-1/GIP receptor agonists. They highlight that compounded products may carry additional risk because they are not FDA-regulated and may vary in formulation and quality.<br /><br />The report concludes that clinicians should counsel patients about warning signs of liver injury, monitor liver tests closely, and stop the suspected drug immediately if liver dysfunction appears. This case underscores the need for heightened vigilance as use of tirzepatide and similar agents continues to expand.

Asset Subtitle

Yugant Patel

Meta Tag

Author List Benjamin Cushing, Christina Leyson, Justin Rueckert, Rani Chikkanna, Sara Rossoll, Vivek Jasti, Yugant Patel

Category Clinical Vignettes

Concept GLP-1 Receptor Agonist

Concept Hepatotoxicity

Concept Drug-Induced Liver Injury

Concept GLP-1/GIP Receptor Agonist

Concept Tirzepatide

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Yugant Patel

Track Adult

Keywords

tirzepatide

drug-induced liver injury

GLP-1/GIP receptor agonist

acute liver failure

liver transplantation

cholestasis

jaundice

hepatotoxicity

compounded medication

autoimmune hepatitis

GLP-1 Receptor Agonist

Hepatotoxicity

Drug-Induced Liver Injury

GLP-1/GIP Receptor Agonist

Tirzepatide