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    B. Focal nodular hyperplasia ?. The cellular and intracellular effects of estrogens depend on their binding to estrogen receptors complexed to heat shock proteins. Some of the effects of estrogens appear to be mediated by paracrine effects of growth factors and cytokines released by adjacent cells. The physiological effects of estrogens are many, including the development of primary and secondary sexual characteristics, increase in the level of various proteins, such as transcortin and ceruloplasmin, as well as various clotting factors, changes in plasma lipids with an increase in high-density lipoprotein, and a reduction in low-density lipoprotein, modification in the renin-angiotensin system, and of bone growth.

    ERE then interact with specific cellular proteins (transacting factors) to activate transcription and regulate the formation of specific mRNAs (1,3). Adverse Effects on the Hepatobiliary System The multiple discrete, possibly adverse effects of these agents on the liver and biliary tract are cited in Table 1, and will be discussed sequentially below. Pregnancy Gallbladder disease Tumor formation Adenoma/carcinoma ?, Adverse Effects of Hormones 719 Table 1 Adverse Effects of Estrogenic Hormones on the Liver and Biliary System Intrahepatic cholestasis Oral contraceptives. HSP is dissociated from the receptor ligand complex, which, in turn, binds to estrogen response elements (ERE) genes.

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