Adrenal-Pituitary Responsiveness During Therapy with an Oral Contraceptive

Abstract

To in-vestigate the effects of oral contraceptives on the hypophyseal-adrenal axis, a series of subjects was studied before and during the cyclic administration of doses of 2 mg and 1 mg of Norethindrone with 0.1 mg of Mestranol. The effect on the Hypothalamic-Pituitary-Adrenal axis was studied by the ACTH stimulation test, the Metopirone test and the Piromen test. Patients were studied between 6 and 25 months of oral contraceptives administration. There was a significant decrease in baseline excretion of urinary 17-KGS [17-ketogenic steroids] and 17-KS [17-ketosteroids]. The response to ACTH was normal, although the first day was somewhat reduced. The response to Metopirone was reduced significantly in 7 out of 8 patients. The plasma cortisol response to Piromen was perfectly normal in the 7 patients in which the test was performed. During the administration of oral contraceptives there is no impairment in Pituitary-Adrenal axis function. The response to exogenous ACTH is within normal limits and although the response to Metopirone is markedly in the majority of patients, such a reaction is not caused by any failure in the release of ACTH, as the response to Piromen is consistently normal. Attention is called to the possibility of misinterpretation of the urinary 17-KGS and 17-KS and their response to Metopirone in patients taking the Pills.