To study the influence of the adrenal gland on plasma
estrogen levels in male patients with
hepatic cirrhosis,
estrone and
estradiol were measured under a variety of experimental conditions. Compared to controls,
estradiol levels were moderately elevated by 26% (P is less than 0.05) in patients with
hepatic cirrhosis (28.5 +/- 5.4 vs. 36.0 +/- 4.7 pg/ml plasma; n: 12), whereas
estrone levels exhibited a two- to threefold increase under basal conditions (32.5 +/- 5.6 vs. 67.8 +/- 20.8 pg/ml; P is less than 0.01).
ACTH application resulted in a striking increase in plasma
estrone levels in both patients with
hepatic cirrhosis and in normal subjects (61.8 +/- 27.5 vs. 27.3 +/- 7.8 pg/ml). During stimulation with
ACTH,
estradiol levels showed no significant changes. After suppression of the adrenal gland by
dexamethasone administered for 5 days, plasma concentrations of
estrone and
estradiol were found to be reduced. The absolute decrease of
estrone was significantly greater in patients with
hepatic cirrhosis than in healthy male subjects (35.5 +/- 12.6 vs. 21.3 +/- 6.0 pg/ml; P is less than 0.05; n: 8).
Estrogen values, however, were still high in patients with
hepatic cirrhosis after 5 days of
dexamethasone administration (37.1 +/- 17.6 pg
estrone/ml and 23.9 +/- 3.6 pg
estradiol/ml plasma). It is suggested that elevated plasma values of
estrogens in this disorder may be derived predominantly from adrenal production. Peripheral conversion of
androgens to
estrone rather than to
estradiol appears to be more effective in sustaining plasma levels of
estrogens in patients with
hepatic cirrhosis.