Gordon G G, Olivo J, Rafil F, Southren A L
J Clin Endocrinol Metab. 1975 Jun;40(6):1018-26. doi: 10.1210/jcem-40-6-1018.
The contribution, by peripheral conversion, of androstenedione and testosterone to the circulating estrogens was determined in men with cirrhosis of the liver. The conversion ratio of androstenedione to estrone, estradiol and testosterone and the conversion ratio of testosterone to estrone (but not estradiol) and androstenedione were significantly increased. The plasma concentrations of androstenedione and testosterone were increased and decreased respectively; the mean plasma concentration of androstenedione being similar to that found in normal women. The metabolic clearance rate of androstenedione was not altered in cirrhosis although the metabolic clearance rate of testosterone was decreased. The production rate of androstenedione was elevated while that of testosterone was reduced. The instantaneous contribution of plasma androstenedione to estrone and estradiol was increased in cirrhosis as was the contribution of testosterone to estrone (but not to estradiol). Thus the increased estradiol levels in cirrhosis result, in large part, from increased peripheral conversion from the androgens. The percent contribution of plasma testosterone to plasma androstenedione was decreased although the absolute amount derived by conversion was normal. The percent contribution of plasma androstenedione to plasma testosterone was increased sevenfold in cirrhosis. The fraction of the daily androstenedione production derived from the plasma testosterone pool was not significantly altered. However, a significant fraction of the daily production rate of testosterone was derived from androstenedione. Thus, 15% of the circulating testosterone is not secreted but is derived by peripheral conversion from androstenedione. Normal levels of gonadotropins were found in cirrhosis.
在肝硬化男性患者中，测定了雄烯二酮和睾酮经外周转化对循环雌激素的贡献。雄烯二酮向雌酮、雌二醇和睾酮的转化比率以及睾酮向雌酮（而非雌二醇）和雄烯二酮的转化比率均显著升高。雄烯二酮和睾酮的血浆浓度分别升高和降低；雄烯二酮的平均血浆浓度与正常女性相似。尽管睾酮的代谢清除率降低，但肝硬化患者中雄烯二酮的代谢清除率未改变。雄烯二酮的生成率升高而睾酮的生成率降低。肝硬化患者中血浆雄烯二酮对雌酮和雌二醇的即时贡献增加，睾酮对雌酮（而非雌二醇）的贡献也增加。因此，肝硬化患者中雌二醇水平升高在很大程度上是由于雄激素外周转化增加所致。血浆睾酮对血浆雄烯二酮的贡献百分比降低，尽管转化产生的绝对量正常。肝硬化患者中血浆雄烯二酮对血浆睾酮的贡献百分比增加了七倍。每日雄烯二酮生成中源自血浆睾酮池的部分未显著改变。然而，每日睾酮生成率的很大一部分源自雄烯二酮。因此，循环睾酮的15%并非分泌产生，而是由雄烯二酮外周转化而来。肝硬化患者的促性腺激素水平正常。
