Developments in jaundice

Thompson, R. P. H.; Williams, Roger

doi:10.1136/pgmj.45.521.196

Cited by 4 publications

(1 citation statement)

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“…The cause of the jaundice of pregnancy (Haemmerli, 1966), or of that due to the combined oestrogen-progestogen contraceptive pill (Thompson and Williams, 1969), is not known, though there is some evidence that oestrogens are responsible. Oestriol may alter the permeability of the biliary tree and reduce bile flow in rats (Forker, 1969).…”

Section: Discussionmentioning

confidence: 99%

Contraception with Chlormadinone Acetate in Woman with Previous Contraceptive Jaundice

Thompson¹,

Williams²

1970

BMJ

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MEDIBALJOURNALprogestogen therapy administered singly, but the available evidence indicates that the oestrogen component alone can account for the abnormalities of glucose tolerance (Javier et al., 1968;Goldman et al., 1968;Goldman and Ovadia, 1969) and blood pyruvate levels oestrogen-progestogen therapy. Circulating plasma cortisol levels are usually normal in obesity, but the cortisol production rate is often increased (Schteingart and Conn, 1965). The hepatic clearance of cortisol is therefore increased and a local effect on hepatic glucose and pyruvate handling is possible. Obesity (Perley and Kipnis, 1966a), oral contraceptive therapy , and glucocorticoid therapy (Perley and Kipnis, 1966b) are associated with raised plasma insulin levels in response to a glucose tolerance test. Since plasma glucose levels are also increased, it appears that there is increased resistance in one or more tissues to the actions of insulin. Studies of pyruvate metabolism using a sodium L (-+) lactate infusion technique have suggested that the abnormally raised blood pyruvate levels in obesity, and during glucocorticoid or oral contraceptive therapy, are caused by an increased proportion of the .glucose load passing down the glycolytic pathway to pyruvate rather than an impaired rate of removal of this metabolite Doar and Cramp, in preparation). If the peripheral insulin resistance referred to above were to affect non-glycolytic pathways of glucose metabolism more than the glycolytic pathway, the combination of raised plasma glucose and insulin levels could result in an increased rate of formation of pyruvate from glucose in certain tissues.The increased variance of blood pyruvate levels in response to a glucose tolerance test in the non-obese oral contraceptive and glucocorticoid groups may reflect the heterogeneous nature of the drug therapy. The type of drug and dose and duration of therapy varied widely within each group. We have been unable to detect, however, a relation between any one of these factors and the change of blood pyruvate levels during oral contraceptive therapy . The increased variance in the control obese group may be due to the greater range of degree of obesity of these subjects compared with that of the non-obese group, since we have previously found a significant correlation (r=032, P<001) between the fasting blood pyruvate level and the degree of obesity in non-diabetic women (Doar et al., 1968). The abnormalities of blood pyruvate levels in response to a glucose tolerance test reported here differ from those observed in maturity-onset diabetes mellitus. In a detailed study (Doar et al., in preparation) we have found no influence of diabetes mellitus (either maturity-onset or insulin-requiring) on the fasting blood pyruvate level. The mean fasting blood pyruvate level, however, was higher in obese than non-obese diabetic subjects. Mean blood pyruvate levels were higher in both obese and non-obese maturity-onset diabetic subjects during the later stages of the test compared with mean blood pyruvate ...

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Section: Discussionmentioning

confidence: 99%