Plasma levels and excretion of estrogens in urine in chronic lever disease.
Plasma levels of nonconjugated estrone (E1), estradiol-17beta (E2), and estriol (E3) and excretion of these estrogens in urine in conjugated and nonconjugated forms were measured by radioimmunoassay in 17 healthy males and 33 males with alcoholic liver disease. Patients with liver disease had significantly elevated plasma levels of E1 (74.2 +/- 8.0 SE versus 26.0 +/- 1.7 pg per ml, P less than 0.001), E2 (29.3 +/- 2.2 versus 23.3 +/- 2.0 pg per ml, P = less than 0.05), and E3 (11.5 + 1.9 versus 6.5 +/- 0.7 pg per ml, P less than 0.01). Excretion of total E1, E2, and E3 in urine was significantly increased in patients with liver disease; the increase was primarily in the nonconjugated fraction. Among those patients with chronic liver disease, the presence of ascites was associated with significantly higher plasma levels of E1 and excretion of larger amounts of E1 and E2 in urine. On the other hand, no differences were observed in the small number of patients with gynecomastia. A direct correlation between the plasma level or excretion of E1 or E2 and several liver function abnormalities was observed. The relative hyperestrogenemia we report here may account for some of the clinical observations in chronic liver disease.