ERNEST URBAN, M.B.; BARRY W. FRANK, M.D.; FRED KERN JR., M.D., F.A.C.P.
A patient with Enovid®-induced jaundice was challenged with the estrogen component, mestranol. Pruritus without jaundice developed on the fifth day. There was prolonged elevation of serum alkaline phosphatase, 45-min sulfobromophthalein (BSP) retention, and a marked increase in plasma bile acids. Maximum secretory transport for BSP by the liver was decreased, and storage capacity was increased. Light microscopy of a liver biopsy showed a few very small canalicular plugs of bile. Challenge with the progestational component, norethynodrel, caused fatigue but no other clinical or biochemical abnormality. The natural estrogen, estradiol, 5 mg daily, caused fatigue, headaches, a transient rise in serum glutamic-oxaloacetic transaminase, and elevation of 45-min BSP retention, but serum alkaline phosphatase and bile acid concentration did not change. Smaller doses of estradiol had no effect. Both components of Enovid are C-17 alkylated compounds, but this radical alone was not responsible for the hepatic toxicity in the patient studied. Both mestranol and estradiol have a phenolic A ring as part of their chemical structure, while norethynodrel does not have this configuration. It is postulated that mestranol and estradiol damage a common pathway for biliary excretion.
URBAN E, FRANK BW, KERN F. Liver Dysfunction with Mestranol but not with Norethynodrel in a Patient with Enovid®-Induced Jaundice. Ann Intern Med. ;68:598–602. doi: 10.7326/0003-4819-68-3-598
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Published: Ann Intern Med. 1968;68(3):598-602.
Gastroenterology/Hepatology, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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