A study of the endocrine manifestations of hepatic cirrhosis

The clinical features and hormonal abnormalities were surveyed in 117 men with cirrhosis of the liver. Compared with healthy men of similar ages, the patients had significantly lower metabolic clearance rates, plasma production rates and total and free levels of testosterone, reduced testosterone responses to human chorionic gonadotrophin stimulation, higher oestradiol, luteinizing hormone and follicle stimulating hormone levels and higher binding capacities of sex steroid binding globulin. The peripheral conversion of testosterone to oestradiol was also found to be significantly increased. However, the metabolic clearance and plasma production rates of oestradiol were not significantly different from those of healthy men. Patients who were severely ill with liver failure and one with haemochromatosis had low levels of luteinizing hormone and follicle stimulating hormone and sub-normal responses to clomiphene and luteinizing hormone-releasing hormone. Higher plasma oestradiol levels were found in patients with gynaecomastia and spider naevi than in those without these signs. However, the clinical features of androgen deficiency--that is, testicular atrophy, impotence and loss of secondary sex hair--were only poorly related to the low testosterone levels, and production rates and longtitudinal studies indicated that the hormonal levels, endocrine features and severity of the liver disease could change independently. It is concluded that the clearance of oestradiol from plasma is not limited by liver disease in all patients, and that reduced degradation of oestrogens is not the initial event in the sequence leading to the hormonal abnormalities of cirrhosis. While gonadotrophin deficiency occurs with liver failure and in some patients with haemochromatosis, the more usual findings are of elevated gonadotrophin levels and a poor Leydig cell response to chorionic gonadotrophin. These suggest that the hypogonadism is primary in most patients with cirrhosis. The causes of the high oestradiol levels were not discovered. Increased peripheral conversion of precursors to oestradiol or increased testicular secretion of oestradiol are possibilities. The high binding capacities of sex steroid binding globulin were not significantly correlated with either the low testosterone or high oestradiol level and the cause of this abnormality remains uncertain. The low metabolic clearance rates of testosterone appeared to result from the increased plasma protein binding of testosterone. The discrepancies in the expected relationships between the hormone and clinical changes suggest that factors other than those studied are also involved in the genesis of the endocrine features of hepatic cirrhosis.

Influence of the oral contraceptive, menstranol, on drug-metabolizing enzymes of female rats in thiamin-supplemented and deficiency states

The administration of a diet deficient in thiamin results in elevated hepatic microsomal activity of aniline hydroxylase, ethylmorphone demethylase, NADPH cytochrome c reductase and cytochrome P-450 when compared to similar female rats fed diets supplemented with thiamin. Accompanying these differences in enzyme activity are increased concentrations of microsomal docosahexaenoic acid and arachidonic acid. Binding of aniline to microsomes from rats fed high levels of thiamin is decreased due to a decrease in cytochrome P-450. On the other hand, the binding of ethylmorphine to P-450 is decreased by feeding high levels of thiamin. The daily administration of mestranol enhanced ethylmorphine and aniline metabolism to a greater extent in rats fed thiamin-rich diet than in rats fed thiamin-deficient diet or laboratory chow. This treatment did not increase cytochrome P-450 cytochrome c reductase or microsomal protein nor does it appear to affect the binding of aniline to cytochrome P-450. Ethylmorphine binding is generally decreased by this treatment. Alterations in the Michaelis constants for these reactions were limited to an increase in the Ks for aniline in pair-fed animals and in the Ks for ethylmorphine in thiamin-deficient rats receiving 1.0 mg mestranol per day.

Induction of lactogenic receptors. II. Studies on the liver of hypophysectomized male rats and on rats bearing a growth hormone secreting tumor

The role of growth hormone (GH), as well as prolactin and ACTH, in the induction of the PRL receptor was investigated both in hypophysectomized male rat livers and in the livers of male rats bearing a GH secreting tumor. After 7 days of s.c. injections, specific binding (% SB) of PRL in controls and rats treated with oPRL, hGH, ACTH, hCG, estradiol (E2), or testosterone (T) was approximately 1%. Treatment with oPRL plus ACTH increased SB to 4%; adding E2 to this combination produced a further increase to 8%, whereas the addition of T decreased hepatic binding to 1%. Combination of hGH with ACTH was most effective, giving a SB of 33%, which is similar to that observed in the liver of rats bearing a GH secreting tumor (36%). These studies suggest that GH acts synergistically with PRL and/or ACTH to increase lactogenic binding sites in the male rat liver and that sex steroids have a modulating effect on this action.

Eight years of fertility control with norgestrel-ethinyl estradiol (Ovral): an updated clinical review

Data on a combination norgestrel-ethinyl estradiol oral contraceptive (Ovral) were obtained from eight large family planning clinics. The safety and efficacy of the drug were evaluated for 6,806 mature, sexually active women who received a total of 127,872 cycles of the medication; this represents 9,836 woman-years of usage. No pregnancy attributable to medication failure occurred, but 19 women who omitted two or more consecutive tablets became pregnant. This produced an overall use-effectiveness pregnancy rate of 0.19/100 woman-years. Cycle control was excellent, and intermenstrual bleeding was rare. Adverse effects were minimal; laboratory values seldom deviated from pretreatment levels. Fertility returned promptly upon withdrawal of the contraceptive, and no infant abnormalities were attributed to its use.

Effect of ethynyl estradiol on the secretion of hepatic triglyceride

The concentrations of triglyceride in the blood of female rats increased 2- and 4-fold during treatment with 5 and 15 mug/kg of ethynyl estradiol, respectively. The rate of secretion of triglyceride increased 66% over controls with livers obtained from the rats administered ethynyl estradiol. Ethynyl estradiol induced a hypocholesterolemia in the donor animals but the secretion of cholesterol into the perfusate from livers obtained from these animal was not affected. Adrenal corticosterone levels were depressed 48% in animals receivint of ethynyl estradiol on the liver or secondary to other hormonal changes.

Elevated concentrations of serum alpha-fetoprotein in rats with chemically induced liver tumors

The study was undertaken to determine whether aflatoxin B1 (AFB1)-induced liver tumors in rats produced alpha1-fetoprotein (AFP) and whether the age of the animals would influence such as appearance, a finding suggested by data seen in man. Other liver carcinogens (N-hydroxy-N-2-fluorenylacetamide, N-2-fluorenylacetamide, and diethylnitrosamine) were tested for their ability to induce liver tumors producing AFP. The presence of AFP. The presence of AFP in the serum was determined by double diffusion in agarose and by comparison also by quantitative radioimmunoassay. Using double diffusion, AFP was detected in the majority of tumor-bearing rats that had received either N-2-fluorenylacetamide or N-hydroxy-N-2-fluorenylacetamide. Sera of diethylinitrosamine-treated rats with liver tumors were all positive, whereas sera of rats bearing AFB1-induced tumors were positive in only a few cases. However, all sera of tumor-bearing rats examined had elevated AFP levels by radioimmunoassay. Nonetheless, the average level of AFP in the sera of rats bearing AFB1-induced tumors was considerably lower, compared to the sera of rats with tumors caused by diethylnitrosamine, N-2-fluorenylacetamide, or N-hydroxy-N2-fluorenylacetamide. Rats started on AFB1 when 6 weeks old had more mixed liver tumors with neoplastic hepatocytes and bile ducts and higher AFP levels than did rats started at 26 weeks of age. However, the histological grade of differentiation of inducted tumors did not seem to influence the AFP level.

[Significance of pruritus during pregnancy. Relations with the hepatic disorders of gestation]

The principal clinical and biological characteristics and the origin of pruritus of pregnancy (p.p.) which occurs in a little more than two pregnancies per thousand are considered in the light of 7 cases. As with recurrent jaundice of pregnancy (r.j.p.), of which pruritus represents a minor analogue, the symptoms occur solely during pregnancy and disappear after delivery. In p.p. signs of cholestasis are seen, more marked than in a normal pregnancy coming to term but less than in icterus gravidarum. The increase in transaminases seen in p.p. and r.j.p. does not occur in normal pregnancy. The two conditions, which may be grouped together under the term hepatogestosis, are benign as far as the mother is concerned but represent a definite and significant risk of prematurity for the child. It is possible to establish a relation between p.p. and/or r.j.p. and the hepatic manifestations associated with oral contraceptives. In both instances a genetic predisposition seems to favour the development of a cholestatic syndrome. A past history of p.p. represents a contraindication to the use of oral contraceptives. Cholestyramine, a bile salt chelator, gives excellent results in persistent p.p.

Hemoperitoneum from liver cell adenoma in a patient on oral contraceptives

A case of hemoperitoneum from ruptured benign liver cell adenoma in a young woman with a long history of oral contraceptive use is presented. The importance of recognizing the cause of this intra-abdominal emergency is stressed, and comment is made about the entity occurring in women on contraceptive drugs.