Pigmentation and oral contraceptives.

Abstract

A 34-year-old woman of parity 2 experienced indefinite abdominal pain loss of weight sweating tremor prostration and pigmentation (including chloasma) of the face upper and lower limbs oral mucosa abdominal operation scar and palmar lines after about 18 months use of the oral contraceptive Lyndiol (lynestrenol mestranol). She discontinued Lyndial and received a dexamethasone suppression test of the pituitary when the 17-OHCS fell from 15.7 mg to 4 mg/24 hours and 17-KS from 8 mg/ 24 hours to 1.2 mg/24 hours. Dexamethasone therapy was continued for two weeks. Abnormal pigmentation and abdominal pain disappeared. Pigmentation reappeared when Lyndiol was tried again apparently due to stimulation of pituitary secretion of melanocyte-stimulating hormone. While some symptoms suggested Addisons disease the normal urine adrenal cortical hormones content and the normal levels of serum electrolytes were contradictory.