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Cholestatic jaundice induced by spontaneous disruption of an oestrogen implant

T E Bowling1, M al-Adnani, D B Silk

  • 1Department of Gastroenterology, Central Middlesex Hospital, London, UK.

European Journal of Gastroenterology & Hepatology
|January 1, 1995
PubMed

Insights

A rare case of estrogen implant fragmentation caused cholestatic jaundice in a woman. Prompt removal and progesterone therapy resolved her symptoms, highlighting a unique clinical presentation.

Area of Science:

  • Endocrinology
  • Hepatology
  • Pharmacology

Background:

  • Subcutaneous hormone implants are used for hormone replacement therapy.
  • Estrogen implants can carry risks, including local reactions and systemic effects.
  • Cholestatic jaundice is a liver condition characterized by impaired bile flow.

Observation:

  • A 48-year-old woman developed jaundice, pruritus, and flu-like symptoms two weeks post-estradiol implant insertion.
  • The estradiol implant was found fragmented upon removal.
  • Elevated estradiol levels (1548 pmol/l) were detected, consistent with estrogen-induced cholestatic jaundice.

Findings:

  • Spontaneous fragmentation of a subcutaneous estradiol implant led to severe estrogen overload.
  • The patient experienced estrogen-induced cholestatic jaundice.
  • Symptomatic resolution occurred after implant removal and initiation of progesterone therapy.

Implications:

  • This case highlights a novel complication of subcutaneous estrogen implants: spontaneous fragmentation leading to cholestatic jaundice.
  • Clinicians should consider implant integrity and potential for fragmentation in patients presenting with unexplained cholestasis after hormone implant therapy.
  • Further research may be warranted to understand the mechanisms and incidence of implant fragmentation.
Abstract

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