Hormone excretion in liver disease.

Gynecomastia, cutaneous spider nevi, testicular atrophy, and loss of libido are frequently found in men with chronic liver disease. The clinical aspects of the subject have recently been reviewed (1). On the basis of studies of urinary estrogen excretion (2), these changes have been attributed to increased levels of estrogens, particularly unconjugated estrogens presumably resulting from decreased conjugation in the diseased liver. This presumption is based on abundant evidence indicating that the liver of certain laboratory animals may "inactivate" estrogens (3), and that Figure 1 shows in diagrammatic fashion some of the factors usually considered in the production and metabolism of estrogens in man. Several authors (3, 8-10) have recently reviewed the metabolism of estrogens, therefore the large amount of data supporting this scheme need not be cited here. The importance of the liver in the metabolism of estrogens is apparent. It will be noted that, if production is constant, the estrogen level of the blood may presumably be modified through: (a) excretion of the material in the urine and bile (and through the intestinal wall?) some being