Vol. 7, Issue 3 (2018)

Author(s):
Dr. Seema Mishra

Abstract:
Accumulated evidence from human and animal studies showed that high levels of estrogen significantly stimulate the activity of 3-hydroxy-3- methylglutaryl coenzyme A (HMG-CoA) reductase, the rate-limiting enzyme in hepatic cholesterol biosynthesis, even under high dietary cholesterol loads. These observations suggest that there may be an increased delivery of cholesterol to bile from de novo synthesis in the liver. Furthermore, studies in humans and animals suggested that estrogen could augment the capacity of dietary cholesterol to induce cholesterol supersaturation of bile. More recently, it is observed that high doses of estrogen significantly enhance intestinal cholesterol absorption, mostly due to an upregulated expression of intestinal sterol influx transporter Niemann-Pick C1 like 1 protein (NPC1L1) via the intestinal ERα pathway. Despite these observations, no information is available on the metabolic abnormalities underlying major sources of the excess cholesterol leading to the super saturation of bile and the formation of cholesterol gallstones induced by estrogen. Randomised controlled trials and observational studies have shown a clear increase in the risk of gallbladder disease (cholelithiasis, cholecystitis, or cholecystectomy as outcomes) with use of hormone replacement therapy by postmenopausal women. Thus, in this study analysis was done to observe the incidence of Gall Stones in HRT users, their biochemical profile related to serum levels of hormones, effect on hepatic efficiency was studied and a positive relation was found between the use of oral route of HRT and incidence of development of cholesterol containing gall stones.