Severe Endogenous Hypertriglyceridemia During Treatment with Estrogen and Oral Contraceptives1

Abstract

Many women taking contraceptives or their estrogen component mestranol develop slightly increased plasma triglycerides (TG). Unusually elevated TG developed in 2 subjects, a woman taking sequential mestranol and chlormadinone acetate, and a diabetic man taking mestranol. Before treatment both patients had mild endogenous hypertriglyceridemia and increased pre-beta lipoproteins. TG levels were 221 and 248 mg/100 ml and reached levels of 1948 in 6 months and of 1240 mg/100 ml in 2 months, respectively. Changes in serum cholesterol paralleled TG but were not as great. Plasma post-heparin lipolytic activity was normal at the height of the hypertriglyceridemia. One patient had initially normal glucose tolerance and the other had diabetic glucose tolerance, and both had high levels of immunoreactive insulin in response to glucose. Clofibrate induced a prompt decrease in the hyperlipemia in one patient. Discontinuation of all treatment was followed by decrease of TG and cholesterol to initial levels, with persistence of high insulin levels.