Liver cell adenoma associated with oral contraceptive hormone therapy.

A patient receiving oral contraceptive hormone therapy developed a hepatic adenoma. Widespread haemorrhages, which were apparently unrelated to trauma, developed in the adenoma. Attention is drawn to the increasing incidence of Pill-associated hepatic tumours, and to the possibility of a fatal haemorrhage.     

Erythema nodosum progressing to pyoderma gangrenosum as a complication of Crohn's disease

Erythema nodosum occurs more frequently than pyoderma gangrenosum in Crohn's disease. We report the occurrence of both lesions in a woman with Crohn's disease and the transformation of one to the other. Pyoderma gangrenosum has been described at the site of previous trauma in Crohn's disease and at the site of other skin conditions in other circumstances, but, to the best of our knowledge, actual progression from erythema nodosum to pyoderma gangrenosum has been reported on only one previous occasion in Crohn's disease.     

Remission of hyperthyroidims and oral contraceptive therapy. [Answer to question

There is no endocrine contraindication to the use of oral contraceptives (OCs) in a 31-year-old nulliparous woman who presumably is in remission from hyperthyroidism. Yet, several important physiological and pathophysiological alterations must be appreciated to evaluate properly thyroid function in persons taking estrogen-containing preparations. Estrogens induce increased hepatic synthesis and release of thyroxine binding globulins (TBGs). Increased serum TBG concentrations result in a new thyroid hormone equilibrium characterized by an elevated serum thyroxine (T4) level and a reduced resin triiodothyronine (T3 uptake) level but a persistently normal serum-free T4 (FT4) level if the patient is euthyroid. When a patient with an increased serum TBG concentration becomes thyrotoxic, the T4 level rises further and the resin T3 uptake increases from low into the normal range. The calculated FT4 level increases into the thyrotoxic range. Thus, in patients with increased serum TBG levels, the calculated FT4 level is the critical serum determinant for laboratory assessment of thyroid function. If the FT4 level is equivocal in evaluating thyrotoxicosis in the presence of increased serum TBG values, then other clinical and laboratory parameters should be used. A thyroid suppression test or a thyrotropin-releasing hormone test might be useful when the serum parameters are not definitive. It is unnecessary to stop the use of OC preparations to evaluate thyroid function. At this time it is unclear whether the use of estrogen-containing medications influences the nature and extent of an autoimmune remission in Graves' disease. There is some evidence that autoimmune thyrotoxicosis is ameliorated or modified by factors in pregnancy.     

Sequential oral contraceptive and breakthrough bleeding

A request for suggestions in management of a 38-year-old woman in good health suffering breakthrough bleeding after 3 years of therapy on ethinyl estradiol plus dimethisterone with ethinyl estradiol (Oracon) for the control of heavy menstrual flow elicited the following response. An extra tablet given on each day of spotting, a double dose for 3 days following bleeding, and an every-other-day double dose are all suggested methods for handling bleeding from oral contraceptives. With a single course of oral diethylstilbestrol 3 mg daily for 25 days combined with a progestational agent on Days 18-25 of each cycle, a return to normal menstrual function can be anticipated in most patients in the absence of some underlying disorder. It is suggested that provoked withdrawal bleeding can mask underlying dysfunction and that this possibility should be eliminated. Long-term steroid administration may incite physiological disturbances.     

Benign breast disease and oral contraceptive use

A random selection of 1,230 upstate New York childbearing women was used to examine the history of oral contraceptive use in women with a clinical diagnosis of benign breast disease. We found that 73 women who had benign breast disease had a reduced duration of pill use. When determining the reason for this reduction, we found that in a significant portion (P less than .05) of our benign breast disease cases, the women had been advised by their physicians to discontinue pill use for breast-related reasons. We then surveyed a large group of upstate New York physicians. One third of them considered benign breast disease a potential contraindication for starting oral contraceptive use. Nearly one half throught the development of benign breast disease to be a potential contraindication for continuing oral contraceptive use. It is premature to conclude that oral contraceptive usage protects against benign breast disease.     

Angioneurotic edema from an oral contraceptive

To the editor:--A 29-year-old white woman was seen April 17, 1967, with a severe angioneurotic edema of the face which had developed suddenly. She had taken aspirin for the two previous days and ethynodiol diacetate with mestranol (Ovulen) for 15 days. Treatment with epinephrine and dexamethasone administered parenterally and diphenhydramine orally did not benefit. Oral contraceptive thereapy was discontinued, and the edema subsided five days later. On April 25, she was asymptomatic. Aspirin had produced no ill effect, and oral contraceptive therapy was started again. After four days edema of the uvula and soft palate appeared, and again medication did not give relief. The edema subsided after a few days during which the patient abstained from cosmetics, tooth pastes, and all allergenic dietary items. Later she resumed all foods and contactants, but has taken no oral contraceptives, and has remained asymptomatic.