Estrogen and androgen dynamics in liver disease.

Constant infusions of 3H-androgen/14C-estrogen were given to 18 men with increased serum bilirubin concentrations and biopsy proven hepatic cirrhosis. From data obtained from the infusions and the radioimmunoassay of circulating endogenous steroid levels metabolic clearance rates (MCR), blood production rates (PB), aromatization rates (fraction of androgen infused into and measured as estrogen in blood; [p]And, Est BB) and conversion ratios (ratio of concentration of radioactivity of infused precursor to product steroid in blood; CRPREC,PROD were calculated. These data were compared to normal data obtained from similar studies in a group of normal men similar in age and weight. The mean concentrations of testosterone (T), and dihydrotestosterone (DHT), were decreased but those of estrone (E1) and estradiol (E2) were increased, and the concentration of androstenedione, (A), was similar compared to the normal values. Compared to the values in normal men the mean MCR of T was decreased those of A and E2 were normal, and that of E1 was slightly increased. However, the PB's of both estrogens were increased while that of A was normal T was decreased. The increase in the PB's of the estrogens could be explained on the basis of a marked increase in [p]And, Est BB probably due to a shift in blood flow from the liver to peripheral tissue. These findings were noted in men with alcoholic cirrhosis as well as cardiac cirrhosis and in 1 subject with infectious hepatitis. Abnormalities in steroid metabolism occur in men with several types of liver disease and are not limited to those with alcoholic liver disease.