Testosterone Therapy for the Pruritus of Obstructive Jaundice

Lloyd-Thomas, H. G.; Sherlock, Sheila

doi:10.1136/bmj.2.4797.1289

Cited by 83 publications

(30 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The relief of itching by the use of methyl testosterone was reported by Lloyd-Thomas and Sherlock in 1952 (22), who commented that the rationale of its use was not known. The lack of effect on the levels of blood and urinary histamine in our patient treated with this hormone suggests that it did not produce the observed relief by correcting the altered metabolism of histamine but rather by some other mechanism.…”

Section: Methodsmentioning

confidence: 99%

Histamine Metabolism in Diseases of The Liver

Mitchell¹,

Butt²,

Code³

1954

J. Clin. Invest.

View full text Add to dashboard Cite

Recent experimental studies in animals indicate that the liver plays a part in the inactivation of histamine in the body, by removing this substance from the blood (1) and by acetylating it to form acetyl or conjugated histamine (2-5). The supposition, therefore, that disorders of hepatic function in man may alter the metabolism of histamine seems reasonable. Some clinical evidence of this is provided by the studies of Chambon and Berthier (6) who found that marked hepatic insufficiency or cirrhosis was often accompanied by high levels of histamine in the blood.A disturbance of histamine metabolism has been held responsible for the pruritus which sometimes occurs in obstructive jaundice (7). Bile salts have been shown to release histamine from the skin (8) and from the liver (1), and Anrep and Barsoum (9) reported that ligature of the common bile duct in dogs caused a rise in blood histamine which they attributed to release of histamine by retained bile.Our study was undertaken to determine whether an abnormal metabolism of histamine could be detected in patients with disordered hepatic function by examination of the blood and urine, and whether in patients with obstructive jaundice any changes which might be found could be related to the degree of itching. METHODS AND MATERIALHistamine was estimated in blood by a modification (10) of the method of Barsoum and Gaddum (11).After the trichloracetic acid filtrate had been boiled with hydrochloric acid and dried twice in the presence of alcohol, the dry material was extracted three times, using 10, 5, and 5 ml. aliquots of absolute alcohol, in order to remove potassium (12). The alcohol-insoluble material was separated by centrifugation, and the alcoholic extract then taken to dryness, The Blood was drawn between 8 and 9 a.m. with syringes moistened with a solution of heparin in saline solution. Samples of the blood in the syringe were taken for determination of histamine arienumetation of epsinophils.The eosinophils were counted aceord#ng to the method of Randolph (13). The amount of bitirubin in the serum was determined according to the method published by Powell (14).Free and conjugated histamine in the urine were measured by the method of Roberts and Adam (15). The mean recovery of free histamine by this procedure is 67 per cent (15, 16); no correction has been made for the loss in the computation of results in this paper.Urine was collected in chemically clean bottles of 2-liter capacity, containing 10 ml. of twice normal hydrochloric acid to maintain the urine at pH 5 or less. Extraction was always started within 24 hours of completing the collection and in the interval the urine was stored in a refrigerator. Tests have shown that no loss of histamine occurs under these conditions.All values for both blood and urinary histamine reported in this paper are the means of duplicate samples, expressed in terms of the free base. Duplicate determinations were made of the histamine content of 24 different samples of urine and 26 different samples of blood. The duplic...

show abstract

Section: Methodsmentioning

confidence: 99%

Histamine Metabolism in Diseases of The Liver

Mitchell¹,

Butt²,

Code³

1954

J. Clin. Invest.

View full text Add to dashboard Cite

show abstract

“…When designing trials, it is important to consider that fatigue persists throughout the course of the disease 13,63 and pruritus may spontaneously improve with disease progression. 72 Recommended Endpoints for Symptoms: 18. Fatigue should be measured by FIS or the fatigue domain of PBC-40.…”

Section: Symptomsmentioning

confidence: 99%

American Association for the Study of Liver Diseases Endpoints Conference: Design and Endpoints for Clinical Trials in Primary Biliary Cirrhosis

et al. 2010

View full text Add to dashboard Cite

PreambleA group of multidisciplinary experts on primary biliary cirrhosis (PBC) and its complications convened on May 31, 2009, under the aegis of the American Association for the Study of Liver Diseases (AASLD) in order to identify the most appropriate design and endpoints for clinical trials of PBC based on current evidence and expert experience. The natural history of PBC was reviewed as well as current therapies. The current approaches to evaluating therapies for disease progression and symptoms as priorities were discussed. Appropriate aspects of trial design including entry criteria, study duration, and appropriate handling of issues such as stratification of subjects and use of ursodeoxycholic acid (UDCA), were identified and discussed. After a full day of presentations, in a consensus manner, appropriate endpoints for clinical efficacy trials regarding PBC and its complications were agreed upon and are reported in this summary.

show abstract

“…The cause of pruritus is not known. One hypothesis is that pruritus may be related to an increase in available endogenous opiates at central opiate receptors [112], This theory is supported by the fact that pruritus can be ameliorated by use of opiate antagonists [113], Despite the fact that the symptom of pruri tus is not clearly related to the accumulation of bile acid or its sequestration in the skin, most patients' symptoms can be effectively treated with bile acid binding resins [114], Other ther apies which have been clinically effective in treating patients with pruritus include acti vated charcoal [ 110], methyltestosterone [115], ondansetron [116], ursodeoxycholic acid [117], ultraviolet phototherapy [118], Sadenosylmethionine [119], phénobarbital [120,121], rifampin [122], plasmapheresis [123], and opiate antagonists such as nalox one hydrochloride and nalmefcne [124], Steatorrhea and malabsorption of fat-solu ble vitamins arc complications which occur in PSC [110], Fat malabsorption in patients which cholestatic liver disease is generally related to a decreased secretion of conjugated bile acids into the small intestine [125], How ever, if steatorrhea develops in the absence of jaundice, then the presence of chronic pancre atitis or celiac disease should be considered [126][127][128], Asymptomatic vitamin A defi ciency has been reported in up to 40-82% of the patients with PSC [129. 130].…”

Section: Management O F Cholestasis and Its Complicationsmentioning

confidence: 94%

Primary Sclerosing Cholangitis: Evolving Concepts in Diagnosis and Treatment

Harnois¹,

Lindor²

1997

Dig Dis

View full text Add to dashboard Cite

Primary sclerosing cholangitis is an increasingly recognized cause of chronic cholestatic liver disease. The etiology is unknown, although a number of immunologic and nonimmunologic factors have been considered. The most important diagnostic findings are diffuse irregularity and narrowing of extrahepatic and intrahepatic bile ducts. The prognosis varies, and a number of relatively unique complications may develop. No adequate treatment exists, although a number of potential treatments have been evaluated. Liver transplantation still remains the most appropriate treatment for end-stage disease. These various topics related to primary sclerosing cholangitis are reviewed.

show abstract

Testosterone Therapy for the Pruritus of Obstructive Jaundice

Cited by 83 publications

References 4 publications

Histamine Metabolism in Diseases of The Liver

Histamine Metabolism in Diseases of The Liver

American Association for the Study of Liver Diseases Endpoints Conference: Design and Endpoints for Clinical Trials in Primary Biliary Cirrhosis

Primary Sclerosing Cholangitis: Evolving Concepts in Diagnosis and Treatment

Contact Info

Product

Resources

About