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LEON HELLMAN, BARNETT ZUMOFF, JACK FISHMAN, T. F. GALLAGHER, Estradiol Metabolism in Total Extrahepatic Biliary Obstruction, The Journal of Clinical Endocrinology & Metabolism, Volume 30, Issue 2, 1 February 1970, Pages 161–165, https://doi.org/10.1210/jcem-30-2-161
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Abstract
The metabolism of iv tracer amounts of 3H-estradiol was studied in 2 men and 2 women with total extrahepatic biliary obstruction. First-day urinary recovery of radioactivity was increased to 48% of the dose (normal 34%) and total recovery to 70% (normal 57%). “Glucosiduronates” were slightly less than normal, and “nonglucosiduronate conjugates” were increased to 39% (normal 12%). These changes probably reflect diversion of estrogen metabolites from the biliary to the urinary route of excretion. There was an abnormal pattern of estrogen metabolites within the “glucosiduronate fraction.” Estriol averaged less than half of normal. 16α-Hydroxyestrone was elevated to 3 times normal in 2 of the patients and was normal in the others. Estrone was slightly elevated. These changes indicate depression of one or both steps of the 16α-hydroxylation pathway (estrone→16α-hydroxyestrone→estriol). Two of the 4 patients showed a decrease in total 2-oxygenated metabolites (2-hydroxyestrone+2-methoxyestrone). The ratio 2-methoxy/2-hydroxy was increased in all patients, to an average of 4 times normal, indicating increased catechol O-methylation. The similarity of these changes to those reported in cirrhosis suggests a major role for cholestasis in the causation of the altered estrogen metabolism of cirrhosis.
