URINARY EXCRETION OF OESTRONE, OESTRADIOL-17β AND OESTRIOL IN PATIENTS WITH CHRONIC LIVER DAMAGE

Abstract

The urinary excretion of oestrone, oestradiol-17\g=b\ and oestriol has been estimated by a chemical technique in nine men and three women with chronic liver disease.Combined oestrone, oestradiol and oestriol excretion was above normal limits in only two patients, both men. One excreted more than normal amounts of all three oestrogens; the other excreted more oestriol only. In addition, four men and one woman excreted more oestriol than normal, but this was not sufficient to increase the combined excretion of these three oestrogens beyond levels found in healthy controls. These findings are contrary to many published conclusions based on bioassay.Oestrogen excretion has been contrasted with the clinical findings. There was no correlation between increased oestrogen excretion and gynaecomastia. There was, however, a suggestive association of increased oestriol excretion, testicular atrophy, and a history of alcoholism. No association was established between an increased excretion of any oestrogen and the presence of ascites, jaundice, spider naevi and palmar erythema. Some implications of these findings are discussed.Patients with chronic liver disease frequently show alteration in their secondary sexual characteristics and sexual function. Men experience, at an early stage of their illness, loss of libido and diminished sexual potency, and clinical examination often reveals small testes, loss of axillary hair, and sometimes enlargement of the breasts.

Oestrogen metabolism and excretion in liver disease

“…The proportion of patients (56 %) with an elevated excretion of urinary oestrogens is higher than in any other group previously reported, a finding which is probably the result of selecting individuals who were most likely to show abnormalities, such as those four with severe complications and the three in terminal liver failure. As shown by Dohan et al (1952) and Cameron (1957) the proportion of oestriol to the other endogenous oestrogens excreted was higher than normal in many patients, indicating that metabolism to this oestrogen is often enhanced in liver disease. However, in two instances (cases 3, 7) the increase was confined to the oestrone fraction, as in the case reported by Lyngbye and Mogensen (1961).…”

“…Glass, Edmonson, and Soll (1940), Rupp, Cantarow, Rakoff, and Paschkis (1951), Pincus, Rakoff, Cohen, andTumen (1951), and Dohan, Richardson, Bluemle, and Gyorgy (1952), using bioassay methods, all found in approximately 48% of the patients studied values which usually were less than twice the normal maximum but occasionally were as high as seven times the normal. Later workers, using colorimetric measurements, have investigated a smaller number of patients and have found raised values in only approximately 20% of the cases, and no value has exceeded twice the normal maximum (Cameron, 1957;Lyngbye and Mogensen, 1961). This raised output has been attributed to impaired metabolism by the diseased liver but evidence for this concept has been conflicting.…”

“…Glass, Edmonson, and Soll (1944) administered oestrone and oestradiol to three patients with liver disease and recovered 83-86% of the biological activity of the administered dose in the urine whereas values of 10% would have been expected for normal individuals. On the other hand, Dohan et al (1952) and Cameron (1957) measured endogenous urinary oestriol, oestrone, and oestradiol separately and found that the major urinary oestrogen in liver disease is often oestriol, which is the least biologically active of the three. After the administration of oestrone, oestradiol, or their esters to patients with liver disease, St0a, Bass0e, and Emberland (1958), in a study of five cases, found a decreased recovery as the three oestrogens in two and an increased recovery in one, and Lyngbye and 'Present address: Royal Women's Hospital, Melbourne, Australia.…”

Alcohol-Induced Ovarian Failure in the Rat

“…An increasing literature suggests that chronic alcohol abuse may induce failure of femnale sexual function (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 6 and 7 ml of blood was obtained from each animal. The liver, ovaries, uterus, and fallopian tubes were removed, trimmed of all extraneous tissue, weighed, and representative sections were placed in Bouin's solution for histological study.…”

Genetic predisposition to carcinoma of the breast: Multiple human genotypes for estrogen 16 alpha hydroxylase activity in caucasians

“…A few cases with Klinefelter's syndrome have also been reported with estrogen metabolism studies, which were distributed comparable to the genotypic males in the distributions of estriol excretion values. Unusually high estriol excretion has been reported from elderly males after myocardial infarction (29), in severe liver disease (15), and in a few males with breast cancer, some of whom had also been castrated (27), or had occlusive arterial disease (61).…”