Liver Dysfunction with Mestranol but not with Norethynodrel in a Patient with Enovid®-Induced Jaundice

Publisher Website
Google Scholar
Abstract
A patient with Enovid-lnduced jaundice was challenged with the estrogen component, mestranol. Pruritus without jaundice developed on the 5th day. There was prolonged elevation of serum alkaline phosphatase, 45-min BSP [sulfobromophthaleln] 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 progestatlonal component, norethynodrel, caused fatigue but no other clinical or persistent biochemical abnormality. The natural estrogen, estradiol, 5 mg daily, caused fatigue, headaches, a transient rise in SGPT [serum glutamic pyruvic transamlnase] 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. Mestranol and estradiol may damage a common pathway for biliary excretion.