Intimal Vascular Lesions Associated With Female Reproductive Steroids

The possibility that endogenous and exogenous female reproductive steroids are a common hormonal factor and may be the common denominator producing an intrinsic vascular lesion was investigated. The 16 cases studied were accessioned in the Armed Forces Institute of Pathology during 1957-1971 and included 5 pregnant women 4 postpartum women and 7 women taking contraceptives. Vascular lesions found in the patients consisted of intimal thickening that produced varying degrees of narrowing of the lumen and only occasionally was associated with overlying thrombus formation. These lesions had serious consequences: myocardial infarction myocardial fibrosis renal failure bowel infarction and pulmonary hypertension and cor pulmonale. Evidence suggested that the intimal lesions were primary intrinsic vascular alterations and that they did not appear to be secondary to systemic disease or to embolization. 3 factors common to the patients were: 1) the vascular system was the site of the lesion 2) intimal proliferation was common to all and 3) they all had the common female reproductive steroid factor related to pregnancy the postpartum state or to the administration of oral contraceptives. Similar vascular changes have been demonstrated in pregnant and postpartum guinea pigs and experimentally in animals receiving female reproductive steroids. Consideration of the total clinico-pathologic profile of the 16 cases studied suggests that exogenous and endogenous steroids should be placed in the list of agents and conditions with which intimal proliferation is associated.