RESUMEN
Women surviving breast cancer in the postmenopausal period suffer from hormonal alternations with adverse effect on mental status and functioning of a number of organs and systems. Two thirds of these women had menopause before the diagnosis of breast cancer. In the remaining one-third ovarian failure is natural or induced by chemotherapy. Doctors cautiously approach the use of estrogen therapy in this group of patients. Their fears are not unsupported bearing in mind known epidemiological data exist linking breast cancer with the use of hormonal therapy. The purpose of this review is to evaluate current data on hormonal use and breast cancer risk.
Asunto(s)
Neoplasias de la Mama/terapia , Terapia de Reemplazo de Estrógeno , Posmenopausia , Terapia de Reemplazo de Estrógeno/efectos adversos , Terapia de Reemplazo de Estrógeno/métodos , Estrógenos/deficiencia , Femenino , Cardiopatías/prevención & control , Humanos , Osteoporosis Posmenopáusica/prevención & control , Polonia , Progestinas/administración & dosificaciónRESUMEN
Total thyroidectomy followed by 131I ablation and thyroxine suppressive therapy is recommended for the treatment of differentiated thyroid carcinomas. Thyroxine should be given at a dose sufficient to suppress TSH to low or undetectable levels. These patients are categorized as subclinical hyperthyroidism subjects. Some cardiovascular effects of subclinical hyperthyroidism, such as an increase in left ventricular mass and accelerated bone loss, should be taken into consideration. Estrogens reduce the loss of bone mass in thyrotoxic postmenopausal patients and have cardioprotective effects. The relatively high incidence of thyroid carcinoma in women suggests that estrogen and/or progesterone may be important for the development of these neoplasms. Immunohistochemical study has established that steroid receptors are present in thyroid tissue. Many authors suggest that estrogens by itself do not appear to affect the natural history of thyroid cancer. Besides the thyroid, active iodide transports catalysed by the sodium/iodide symporter occurs in the lactating mammary gland. An increased risk of breast carcinoma in women with thyroid carcinoma due to carcinogenicity of radioiodine has been reported by some but not all investigators. Hormone replacement therapy in the thyroxine treated postmenopausal women consists in conventional oral or transdermal estrogen combined with progesterone. In some cases the daily dose of thyroxine should be increased to achieve TSH suppression.
Asunto(s)
Estrógenos/administración & dosificación , Terapia de Reemplazo de Hormonas , Neoplasias de la Tiroides/tratamiento farmacológico , Neoplasias de la Tiroides/cirugía , Tiroxina/administración & dosificación , Administración Cutánea , Administración Oral , Femenino , Humanos , Osteoporosis/inducido químicamente , Osteoporosis/prevención & control , Cuidados Posoperatorios , Progesterona/administración & dosificación , Tiroidectomía , Tiroxina/efectos adversosRESUMEN
UNLABELLED: The aim of the study was to estimate the dose of thyroxine required by pregnant women who had undergone total thyreoidectomy and radioiodine treatment for thyroid cancer. Material consisted of 4 pregnant women, aged mean 30.8 years. One of patients was studied during 2 consecutive pregnancies. The daily mean dose of thyroxine was 175 micrograms. The control group consisted of 7 women with primary hypothyroidism aged mean 33.5 years, who were treated with replacement doses of thyroxine. One of them was pregnant twice. The mean daily dose of thyroxine was 106.3 micrograms. The estimation of TSH, fT4 were repeated every 4 weeks. RESULTS: In all cases natural deliveries took place. All infants were alive and had no congenital malformations and no clinical or biochemical thyroid dysfunction was found. Pregnant women treated for thyroid cancer needed to have optimized their suppressive therapy by increasing the dose of thyroxine by 26% at the first trimester, 27% at the second and 38% at the last one. Statistically significant increase was found at the 1st trimester of pregnancy and it remained at the same level till the delivery. Pregnant hypothyroid women needed to have optimized their replacement thyroxine therapy by increasing of the dose by 53% at the first trimester, by 49% at the second and by 53% at the last one. Similarly to the 1st group of patients, we noticed statistically significant increase at the 1st trimester of pregnancy. CONCLUSION: In pregnant women who have been previously treated for thyroid cancer the suppressive dose of thyroxine needs to be increased by 26-38% which is slightly less than the increase of the replacement dose in hypothyroid pregnant women.
Asunto(s)
Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Neoplasias de la Tiroides/tratamiento farmacológico , Tiroxina/administración & dosificación , Adulto , Femenino , Humanos , Recién Nacido , Radioisótopos de Yodo/uso terapéutico , Embarazo , Complicaciones Neoplásicas del Embarazo/sangre , Complicaciones Neoplásicas del Embarazo/cirugía , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tiroxina/sangre , Resultado del TratamientoRESUMEN
A typical three generation-family with MEN 2A (Multiple Endocrine Neoplasia, Type 2A) is described. Two brothers and their uncle were affected with medullary thyroid carcinoma (MTC) and pheochromocytoma. The diagnosis of MTC was based on calcitonin determinations after pentagastrin stimulation. Pheochromocytoma was clinically silent in two cases. A family screening with pentagastrin test led to the diagnosis of C cell hyperplasia in a 8-year boy, who was then successfully operated on. The authors discuss the value of pentagastrin test and genetic testing in the early diagnosis of MTC associated with MEN 2A syndrome.
Asunto(s)
Carcinoma/diagnóstico , Carcinoma/genética , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2a/genética , Feocromocitoma/diagnóstico , Feocromocitoma/genética , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Adulto , Calcitonina/sangre , Niño , Fármacos Gastrointestinales , Humanos , Masculino , Pentagastrina , SíndromeRESUMEN
UNLABELLED: The relationship of growth hormone (GH) to the ageing process is currently subject of considerably interest. The study was designed to investigate the effects of replacement therapy with growth hormone on quality of life, serum lipids and body composition (fat free mass and fat mass) in elderly men. MATERIAL: 18 healthy men 60.0 +/- 2.4 (x +/- SEM) years of age. Their body weight was 78.6 +/- 4.6 kg and body mass index (BMI) was 26.5 +/- 1.4 kg/m2. Diagnosis of GH deficiency was based on serum insulin-like growth factor-1 (IGF-1) levels below 200 micrograms/L (138.1 +/- 9.2), abolished GH nocturnal surge and diminished glucagon-stimulated GH secretion compared to reference group of young men (16.2 +/- 1.8 to 30.6 +/- 4.7 micrograms/L/hour; p < 0.02 and 10.8 +/- 1.0 to 44.1 +/- 15.3 micrograms/L/hour; p < 0.02, respectively). Reference group comprised nine men 27.5 +/- 1.3 years of age with body weight 76.3 +/- 2.2 kg and BMI 23.1 +/- 0.6 kg/m2. The subjects received recombinant, human GH daily subcutaneously during 12 months in dose adjusted to maintain optimal (280-350 micrograms/L) serum IGF-1 level. The initial dose was 0.125 IU/kg b.w./week. Before, and after 6 and 12 months of therapy clinical and laboratory exams, including serum GH, IGF-1 and lipids levels, and body composition using two methods were obtained. Quality of life was assessed by modified Beck's questionnaire. 12-months replacement therapy with growth hormone in elderly men improved mental status, increased serum IGF-1 level to the young normal men values, from 138.1 +/- 9.2 to 279.4 +/- 26.3 micrograms/L, p < 0.001, reduced serum LDL-cholesterol from 3.67 +/- 0.12 to 3.10 +/- 0.21 mmol/L, p < 0.04 and increased serum HDL and HDL2 levels from 1.20 +/- 0.05 to 1.41 +/- 0.08 mmol/L, p < 0.002 and from 0.19 +/- 0.03 to 0.34 +/- 0.06 mmol/L, p < 0.005, respectively, reduced fat mass (12.8%, p < 003), particularly localised in trunk (14.7%, p < 0.03), and increased fat free mass (2.9%, p < 0.03). GH-replacement therapy in elderly men has beneficial effects on quality of life, and may counteract ageing and atherosclerosis progression by serum lipids and body composition improvement.
Asunto(s)
Hormona del Crecimiento/farmacología , Hormona de Crecimiento Humana/efectos de los fármacos , Hormona de Crecimiento Humana/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Composición Corporal/efectos de los fármacos , Índice de Masa Corporal , Peso Corporal/efectos de los fármacos , Hormona del Crecimiento/uso terapéutico , Humanos , Inyecciones Subcutáneas , Lipoproteínas/sangre , Lipoproteínas/efectos de los fármacos , Masculino , Persona de Mediana Edad , Calidad de VidaAsunto(s)
Acromegalia/tratamiento farmacológico , Antineoplásicos/uso terapéutico , Tumor Carcinoide/metabolismo , Hormona Liberadora de Hormona del Crecimiento/metabolismo , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Neoplasias de la Tiroides/metabolismo , Acromegalia/etiología , Adulto , Tumor Carcinoide/complicaciones , Tumor Carcinoide/secundario , Humanos , Masculino , Somatostatina/uso terapéutico , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/secundarioRESUMEN
The aim of this study was to determine the influence of testosterone replacement therapy in elderly men on mood, bone mineral density, and lipids. We investigated thirty men (mean +/- SD; age 61.1 +/- 5.6 yr) with testosterone concentrations (mean +/- SEM) 2.1 +/- 0.2 ng/ml. Testosterone deficiency was replacement by intramuscular injections of testosterone enanthate 200 mg every second week from 1.5 to 6 yr. (mean +/- SD; 3.35 +/- 1.6 yr.). During the treatment serum testosterone increased reaching normal levels (mean +/- SEM; 6.6 +/- 0.2 ng/ml). This was associated with significant increase in positive mood parameters and a decrease in negative mood parameters. Also self assessment of libido, potence and dream were improved. Bone mineral density (BMD) of lumbar spine increased. We noticed significant decrease in total cholesterol, and LDL-cholesterol. Hematocrit was increase Prostate-specific antigen concentration statistically increased from 0.65 +/- 0.1 to 1.35 +/- 0.1 ng/ml (mean +/- SEM), but in the cases of its levels were in normal range. Patients with coronary heart disease demonstrated decreasing ing symptoms of angina pectoris and nitrate requirement. In summary, long-term testosterone replacement therapy in elderly men may have beneficial effects on well-being, libido, potence, dream, bone mineral density, lipids, blood cell count and body mass (BMI). This therapy appears to be safe and there is no adverse effection on prostate.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Terapia de Reemplazo de Hormonas , Lípidos/sangre , Testosterona/análogos & derivados , Afecto/efectos de los fármacos , Anciano , Colesterol/sangre , LDL-Colesterol/sangre , Hematócrito , Humanos , Inyecciones Intramusculares , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/efectos de los fármacos , Radiografía , Testosterona/sangre , Testosterona/farmacología , Testosterona/uso terapéuticoRESUMEN
OBJECTIVE: Decline in growth hormone (GH) secretion and serum levels of insulin-like growth factor-1 (IGF-1) during ageing may be a causal factor in the development of osteopenia. The purpose of this study was to test the effects of GH-replacement therapy on bone metabolism and mineral density in healthy men over 40 years old. MATERIAL: 18 healthy men aged 60.2 +/- 2.4 (avg +/- SEM) with mean body weight 78.6 +/- 4.6 kg and body mass index (BMI) 26.5 +/- 1.4 kg/m2. Diagnosis of growth hormone deficiency was based on serum IGF-1 levels below 200 micrograms/L (138.1 +/- 9.2), abolished GH nocturnal surge and diminished glucagon-stimulated GH secretion compared to reference group of young men (16.2 +/- 1.8 to 30.6 +/- 4.7 micrograms/L/hour; p < 0.02 and 10.8 +/- 1.0 to 44.1 +/- 15.3 micrograms/L/hour; p < 0.02 respectively). Nine healthy men aged 27.5 +/- 1.3 were recruited as a control subjects. Their body weight was 76.3 +/- 2.2 kg and BMI 21.3 +/- 0.6 kg/m2. METHODS: The subjects received human, recombinant GH (rhGH) daily subcutaneously during 12 months in dose individually adjusted to maintain optimal (280-350 micrograms/L) serum IGF-1 level. Initial dose was 0.125 IU/kg b.w./week. Before and after 6 and 12 months of therapy clinical and laboratory exams, including serum GH, IGF-1, calcium, phosphate, osteocalcin, glucose, insulin levels and alkaline phosphatase (AP) activity were obtained. Lumbar spine and femoral neck bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry. RESULTS: rhGH administration for 12 months led to a significant increase in mean serum IGF-1 levels, from 138.1 +/- 9.2 to 279.4 +/- 26.3 micrograms/L (p < 0.001). Mean serum osteocalcin concentration rose from 19.4 +/- 1.7 to 34.4 +/- 4.7 micrograms/L (p < 0.004), and serum AP activity changed nearly significantly, from 78.0 +/- 4.8 to 88.1 +/- 7.2 U/L. Lumbar spine and femur neck BMD increased significantly after 12 months, from 1.092 +/- 0.05 to 1.119 +/- 0.06 g/cm2 (p < 0.05) and from 0.886 +/- 0.04 to 0.905 +/- 0.04 g/cm2 (p < 0.05), respectively. CONCLUSION: Growth hormone replacement therapy in elderly men may be regarded as a method useful to protect against osteoporosis progression.
Asunto(s)
Envejecimiento/metabolismo , Densidad Ósea/efectos de los fármacos , Enfermedades Óseas Metabólicas/prevención & control , Sustancias de Crecimiento/administración & dosificación , Sustancias de Crecimiento/deficiencia , Adulto , Anciano , Anciano de 80 o más Años , Fosfatasa Alcalina/sangre , Esquema de Medicación , Cuello Femoral/diagnóstico por imagen , Sustancias de Crecimiento/sangre , Humanos , Inyecciones Subcutáneas , Factor I del Crecimiento Similar a la Insulina/análisis , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteocalcina/sangre , Radiografía , Proteínas RecombinantesAsunto(s)
Diabetes Mellitus Tipo 1/sangre , Hormona Liberadora de Hormona del Crecimiento/antagonistas & inhibidores , Octreótido/farmacología , Adulto , Glucemia/metabolismo , Femenino , Hormona Liberadora de Hormona del Crecimiento/sangre , Humanos , Inyecciones Subcutáneas , Masculino , Octreótido/administración & dosificaciónRESUMEN
We investigated the effects of long-term testosterone replacement in hypogonadal and elderly men on lipids and lipoproteins. Twenty-two men with initial serum testosterone concentrations below 3.5 ng/ml took part in the study: 11 with hypopituitarism (1st group) and 11 otherwise healthy elderly men with low testosterone levels (2nd group). Testosterone deficiency was replaced by intramuscular injections of testosterone enanthate 200 mg every second week. Plasma levels of sex hormones, gonadotropins, SHBG, lipids and lipoproteins were determined before the treatment and after 3, 6 and 12 months of treatment. During the treatment serum testosterone and estradiol increased significantly, reaching normal levels. This was associated with a decrease in total cholesterol (from 225 +/- 16.9 mg/dl to 202 +/- 13.6 mg/dl after 6 months and 198 +/- 12.8 mg/dl after 1 year of testosterone administration, P < 0.0001 in men with hypoandrogenism associated with aging and from 255 +/- 12.1 mg/dl to 214 +/- 10.6 mg/dl after 6 months and 206 +/- 9 mg/dl after 1 year of treatment, P < 0.0001 in men with hypopituitarism) and LDL-cholesterol concentrations (from 139 +/- 12.5 mg/dl to 126 +/- 10.7 mg/dl after 6 months and 118 +/- 9.8 mg/dl after 1 year of testosterone administration, P < 0.0001 in men with hypoandrogenism associated with aging and from 178 +/- 10.3 mg/dl to 149 +/- 10.2 mg/dl after 6 months and 140 +/- 7.3 mg/dl after 1 year of treatment, P < 0.001 in men with hypopituitarism). However, no significant decrease in HDL-cholesterol levels or HDL2- and HDL3-cholesterol subfractions was observed. The effects of testosterone replacement therapy on lipids and lipoproteins were similar in both groups with different aetiology of hypogonadism. No side effects on the prostate were observed. The results of this study indicate that testosterone replacement therapy in hypogonadal and elderly men may have a beneficial effect on lipid metabolism through decreasing total cholesterol and atherogenic fraction of LDL-cholesterol without significant alterations in HDL-cholesterol levels or its subfractions HDL2-C and HDL3-C.
Asunto(s)
Arteriosclerosis/prevención & control , Hipogonadismo/tratamiento farmacológico , Lípidos/sangre , Lipoproteínas/sangre , Testosterona/análogos & derivados , Adolescente , Adulto , Anciano , Envejecimiento/sangre , Arteriosclerosis/epidemiología , Hormonas Esteroides Gonadales/sangre , Gonadotropinas Hipofisarias/sangre , Humanos , Hipopituitarismo/sangre , Hipopituitarismo/tratamiento farmacológico , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Factores de Riesgo , Globulina de Unión a Hormona Sexual/análisis , Testosterona/administración & dosificación , Testosterona/sangre , Testosterona/uso terapéuticoRESUMEN
OBJECTIVES: The purpose of the study was to establish plasma levels of insulin, ovarian sex hormones and dehydroepiandrosterone sulfate (DHEA-S) and to evaluate their correlations with lipids in premenopausal women with angiographically demonstrated coronary stenosis. DESIGN: Differences in plasma levels of insulin, ovarian sex hormones, DHEA-S and lipids between groups were compared by analysis of variance. SETTING: From January 1993 until December 1993 patients were diagnosed in the Outpatient Clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw. SUBJECTS: Premenopausal women with normal oral glucose tolerance test (OGTT) results, with and without coronary stenosis were studied: 21 women after acute myocardial infarction with angiographically demonstrated coronary stenosis (women with CHD), and 14 women with chest pain, a positive exercise test without significant changes of coronary arteries on coronarography (women with normal coronarography, NC). The control group consisted of nine, healthy women with no risk factors for CHD. MAIN OUTCOME MEASURES: In premenopausal women with CHD, the decreased plasma level of DHEA-S and hyperinsulinaemia were anticipated. RESULTS: In women with CHD, the plasma levels of DHEA-S (926.5 +/- 83 ng mL-1) were significantly lower than those in women with NC (1375.7 +/- 181 ng mL-1) and in healthy controls (1984 +/- 127 ng mL-1), P < 0.02 and P < 0.001, respectively. The fasting insulin and insulin response to an OGTT in women with CHD and with NC was higher than in healthy subjects. A significant decrease of high-density lipoprotein (HDL) cholesterol, HDL-2 cholesterol and apolipoprotein A-I, and an increase of total cholesterol, low-density lipoprotein cholesterol C and apolipoprotein B levels in women with CHD compared to healthy controls were observed. A negative correlation between fasting insulin and the plasma levels of DHEA-S was established. CONCLUSION: In premenopausal women, hyperinsulinaemia and decreased DHEA-S levels may contribute to the development of coronary atherosclerosis.
Asunto(s)
Enfermedad Coronaria/sangre , Deshidroepiandrosterona/análogos & derivados , Hormonas Esteroides Gonadales/sangre , Hiperinsulinismo/complicaciones , Premenopausia/sangre , Adulto , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/etiología , Deshidroepiandrosterona/sangre , Sulfato de Deshidroepiandrosterona , Femenino , Humanos , Hiperinsulinismo/sangre , Insulina/sangre , Lípidos/sangre , Persona de Mediana EdadRESUMEN
BACKGROUND: Adrenocortical carcinoma is a rare tumor with a poor prognosis. This work was aimed at analyzing the clinical outlook and treatment results of 52 patients with this disease. METHODS: This study included patients with adrenocortical carcinoma referred to the Department of Endocrinology at the Center of Postgraduate Medical Education (Warsaw, Poland) during the last 30 years. In 11 patients, the adrenal tumor was found incidentally by ultrasonographic scan. Hormonal examinations made it possible to define the endocrine activity of the tumors, whereas imaging techniques helped to determine their staging. Forty-eight patients underwent surgery, and 36 of them received mitotane. This drug was administered to 26 patients for a range of 10 months to 10 years; 13 patients received mitotane immediately after the operation, and 13 others after a delay. The patients with severe hypercorticism were pretreated before surgery with aminoglutethimide and mitotane. RESULTS: The study comprised 10 men and 42 women; hormonally active tumors were diagnosed in 39 of them. Cushing's syndrome was the most frequent entity. At diagnosis, 17 cases were classified as localized disease, 15 as regional disease, and 20 as distant disease. Pretreatment with the inhibitors of steroidogenesis improved the survival perspectives in the early postoperative period. As of this writing, there were 12 survivors in the group of 26 patients treated by surgery and long term mitotane therapy and only 2 survivors of 7 patients treated with surgery only. CONCLUSIONS: Surgery with immediate adjuvant long term mitotane administration was the most effective form of therapy for patients with adrenocortical carcinoma.
Asunto(s)
Neoplasias de la Corteza Suprarrenal/cirugía , Carcinoma Corticosuprarrenal/cirugía , 17-Hidroxicorticoesteroides/orina , 17-Cetosteroides/orina , Adolescente , Neoplasias de la Corteza Suprarrenal/tratamiento farmacológico , Neoplasias de la Corteza Suprarrenal/patología , Carcinoma Corticosuprarrenal/tratamiento farmacológico , Carcinoma Corticosuprarrenal/patología , Hiperfunción de las Glándulas Suprarrenales/tratamiento farmacológico , Adulto , Anciano , Aminoglutetimida/uso terapéutico , Quimioterapia Adyuvante , Síndrome de Cushing/cirugía , Femenino , Estudios de Seguimiento , Hormona del Crecimiento/sangre , Hormona Liberadora de Hormona del Crecimiento/sangre , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Mitotano/uso terapéutico , Estadificación de Neoplasias , Tasa de Supervivencia , Testosterona/sangre , Resultado del TratamientoRESUMEN
OBJECTIVES: The purpose of the study was to evaluate the effect of transdermal 17 beta-oestradiol with oral progestogen on the plasma levels of lipids, lipoproteins and apolipoproteins in hypercholesterolaemic postmenopausal women. DESIGN: During 6 months of replacement therapy with transdermal 17 beta-oestradiol combined with oral progestogen, plasma lipids, lipoproteins and apolipoproteins after 3 and 6 months were measured and compared with pretreatment values by Student's t-test. SETTING: From January 1992 until September 1992 patients were diagnosed and treated in an out-patient clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw. SUBJECTS: The patients studied were 11 non-obese postmenopausal women with hypercholesterolaemia based on the World Health Organization criteria. INTERVENTIONS: Venous blood samples were obtained before and 3 and 6 months after the beginning of cyclic replacement therapy with transdermal 17 beta-oestradiol (E2 100 micrograms day-1 combined with oral chlormadinone acetate (2 mg day-1 for 7 days in each cycle). MAIN OUTCOME MEASURES: The antiatherogenic effect of transdermal oestrogen replacement therapy exerted by increased levels of high-density lipoprotein subfraction 2 cholesterol (HDL2-C) leading to the decrease of the total cholesterol level was anticipated. RESULTS: After 6 months of the treatment the concentrations of HDL2 cholesterol (HDL2-C) increased from 0.45 +/- 0.07 mmol l-1 to 0.73 +/- 0.03 mol l-1 (P < 0.05) but the levels of HDL3 cholesterol (HDL3-C) decreased from 1.15 +/- 0.06 mmol l-1 to 0.89 +/- 0.07 mmol l-1 (P < 0.05). The concentrations of total cholesterol decreased from 6.9 +/- 0.13 mmol l-1 to 6.2 +/- 0.2 mmol l-1 (P < 0.05). No changes were observed in the plasma levels of total triglycerides, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, VLDL triglycerides, apolipoproteins A-I and B. CONCLUSIONS: In hypercholesterolaemic postmenopausal women, transdermally administered 17 beta-oestradiol 100 micrograms daily in combination with oral chlormadinone acetate has a beneficial effect through raising the level of the antiatherogenic HDL2-C subfraction and decreasing the level of total cholesterol.
Asunto(s)
Acetato de Clormadinona/farmacología , Estradiol/farmacología , Terapia de Reemplazo de Estrógeno , Hipercolesterolemia/sangre , Lípidos/sangre , Posmenopausia/sangre , Administración Cutánea , Administración Oral , Adulto , Acetato de Clormadinona/administración & dosificación , Estradiol/administración & dosificación , Femenino , Humanos , Hipercolesterolemia/tratamiento farmacológico , Lipoproteínas/sangre , Lipoproteínas/efectos de los fármacos , Persona de Mediana EdadRESUMEN
Large doses of pirenzepine given at bedtime suppress nocturnal GH secretion and abolish dawn phenomenon. As GH suppression may be beneficial in diabetic subjects we have investigated the effect of routine doses of pirenzepine on GH secretion in 9 type 1 diabetics. In the acute study pirenzepine 20 mg i.v. administered 15 min before GHRH 80 micrograms i.v. completely inhibited GHRH-induced GH response and the peak GH values were reduced from 66.3 to 9.2 ng/ml, P < 0.005. In the chronic study pirenzepine was given in a daily dose of 75 or 150 mg for 4 days and GH was measured hourly during 24-h study before and on the fourth day of pirenzepine administration. GH secretion calculated as area under curve (AUC) was not affected by pirenzepine and the values of AUC were: 139 ng/ml per h (the control 24-h study) and 123 ng/ml per h (pirenzepine 75 mg) and 303 ng/ml per h (pirenzepine 150 mg). Mean plasma glucose was not changed by pirenzepine. GH secretion calculated as AUC and mean 24-h GH level did not correlate with metabolic control of diabetes assessed by HbA1. It is concluded that routine doses of pirenzepine do not suppress GH hypersecretion in type 1 diabetic subjects and therefore this agent does not seem suitable for the purpose of 24-h GH suppression in type 1 diabetes mellitus.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 1/sangre , Hormona Liberadora de Hormona del Crecimiento , Hormona del Crecimiento/metabolismo , Pirenzepina/farmacología , Pirenzepina/uso terapéutico , Adulto , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Hormona del Crecimiento/sangre , Humanos , Cinética , MasculinoRESUMEN
The effect of pirenzepine, a peripheric cholinergic antagonist, on GHRH-induced GH secretion was studied in 10 type I diabetic subjects and 8 healthy controls. GH response was significantly greater in diabetics than in the healthy controls (p < 0.02) with peak values of 59.6 and 15.9 ng/ml, respectively. Pirenzepine 20 mg in given 15 min before GHRH inhibited GH response in both groups. In diabetics GH response calculated as area under curve (AUC) was inhibited from 3666 to 260 ng/ml. min (p < 0.001) and in the controls from 831 to 255 ng/ml. min (p < 0.05). The great efficacy of pirenzepine in inhibiting GH hypersecretion in type I diabetes may find a clinical application in future.
Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Hormona Liberadora de Hormona del Crecimiento/farmacología , Hormona del Crecimiento/metabolismo , Pirenzepina/farmacología , Receptores Muscarínicos/efectos de los fármacos , Adulto , Depresión Química , Femenino , Hormona del Crecimiento/antagonistas & inhibidores , Hormona Liberadora de Hormona del Crecimiento/antagonistas & inhibidores , Humanos , Masculino , Parasimpatolíticos , Receptores Muscarínicos/fisiología , Valores de ReferenciaRESUMEN
In order to evaluate the effect of postmenopausal estrogen replacement therapy on the plasma levels of the insulin-like growth factor-I (IGF-I) 12 postmenopausal women aged 44 to 59 years were studied. The control group consisted of 15 healthy premenopausal women aged 20-44 years. In the postmenopausal women the plasma levels of IGF-I, gonadotrophins and sex hormones were determined before and after 3 and 6 months cyclic replacement therapy with transdermal 17 beta-estradiol (E2 100 micrograms patches applied twice weekly) combined with oral chlormadinone acetate (2 mg daily for 7 days in each cycle). Basal levels of estradiol (E2), IGF-I, dehydroepiandrosterone sulphate (DHEA-S), testosterone and androstenedione were lower, but gonadotropin levels were higher in postmenopausal than in premenopausal women. In all the women studied age was inversely correlated with IGF-I levels (r = -0.793, p less than 0.001) and with DHEA-S concentrations (r = -0.435, p less than 0.02). In postmenopausal women transdermal estradiol administration restored the circulating E2 levels to the early follicular range and increased the IGF-I levels (from 76.4 +/- 9.2 micrograms/l to 141.8 +/- 20.8 micrograms/l; p less than 0.01). Transdermal estradiol decreased gonadotrophin levels without changes in concentration of DHEA-S, testosterone, androstenedione and SHBG. In postmenopausal women before and during replacement therapy a positive correlation was found between estradiol and IGF-I concentrations (r = -0.439, p less than 0.01). These results suggest that cyclic replacement therapy with transdermal 17 beta-estradiol in combination with chlormadinone acetate given orally increase the plasma levels of IGF-I in postmenopausal women.
Asunto(s)
Acetato de Clormadinona/uso terapéutico , Estradiol/farmacología , Terapia de Reemplazo de Estrógeno , Factor I del Crecimiento Similar a la Insulina/metabolismo , Administración Cutánea , Administración Oral , Adulto , Acetato de Clormadinona/administración & dosificación , Deshidroepiandrosterona/análogos & derivados , Deshidroepiandrosterona/sangre , Sulfato de Deshidroepiandrosterona , Quimioterapia Combinada , Estradiol/administración & dosificación , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Ensayo Inmunorradiométrico , Hormona Luteinizante/sangre , Menopausia , Persona de Mediana Edad , Hipófisis/metabolismo , Radioinmunoensayo , Globulina de Unión a Hormona Sexual/metabolismo , Testosterona/sangreRESUMEN
In order to evaluate the GH/insulin-like growth factor-I (IGF-I) axis in the polycystic ovary syndrome (PCO), 21 women aged 18-38 yr were studied. The GH responses to the GH-releasing hormone (GHRH), and plasma concentrations of IGF-I were measured in seven obese women with PCO, seven obese healthy controls without PCO, and in seven nonobese subjects. Total GH secretion, as expressed by the integrated GH response to GHRH, in PCO obese women (617.4 +/- 150 micrograms/L.min) and in obese women without PCO (327.1 +/- 161.4 micrograms/L.min) were lower than that in nonobese healthy controls (3181.4 +/- 644.3 micrograms/L.min, P less than 0.001 and P less than 0.001, respectively). Plasma concentrations of IGF-I in obese PCO women (199.5 +/- 39.1 micrograms/L), and in obese women without PCO (192.4 +/- 36.8 micrograms/L) were similar to the IGF-I levels in nonobese controls (224.3 +/- 33.2 micrograms/L). In obese women with and without PCO, a negative correlation was found between the body mass index and the peak GH responses to GHRH (r = -0.639, P less than 0.02) and between age and IGF-I levels (r = -0.520, P less than 0.05). These findings suggest that an abnormality of the GH/IGF-I axis in PCO women may be due to coexistent obesity.
Asunto(s)
Hormona Liberadora de Hormona del Crecimiento , Hormona del Crecimiento/metabolismo , Factor I del Crecimiento Similar a la Insulina/metabolismo , Obesidad/fisiopatología , Síndrome del Ovario Poliquístico/fisiopatología , 17-alfa-Hidroxiprogesterona , Adulto , Análisis de Varianza , Glucemia/metabolismo , Deshidroepiandrosterona/análogos & derivados , Deshidroepiandrosterona/sangre , Sulfato de Deshidroepiandrosterona , Femenino , Hormona del Crecimiento/sangre , Humanos , Hidroxiprogesteronas/sangre , Insulina/sangre , Obesidad/sangre , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Valores de Referencia , Globulina de Unión a Hormona Sexual/análisis , Testosterona/sangreRESUMEN
UNLABELLED: In our previous study we showed that alcohol disturbed the circadian rhythms of LH, testosterone and its conversion to DHT. To determine the effect of LH-RH on pituitary-gonadal function before and after alcohol, 11 male volunteers aged 24-29 years (mean 25.5) were investigated. Blood for hormonal estimations was withdrawn before and 20, 30, 60, and 120 min after LH-RH. In every case, the LH-RH test was performed twice: 6 hours after placebo and, a week later, 6 hours after alcohol administered orally, in dose of 1.0 g/kg bw. The LH, FSH, alpha-subunit and testosterone concentrations were measured with radioimmunological methods. RESULTS: It was shown that alcohol significantly inhibited LH (p < 0.05), alpha-subunit (p < 0.02) and testosterone (p < 0.001) response to LH-RH stimulation, but not that of FSH.
Asunto(s)
Etanol/farmacología , Hormonas Glicoproteicas de Subunidad alfa/metabolismo , Hormona Liberadora de Gonadotropina/fisiología , Hormona Luteinizante/metabolismo , Testosterona/metabolismo , Adulto , Humanos , Masculino , RadioinmunoensayoRESUMEN
The radioimmunoassay of alpha-subunit adapted in our laboratory was widely evaluated. Three different antisera (anti-pituitary alpha-subunit, anti-alpha-TSH and anti-alpha-hCG), the labelled preparations of pituitary alpha-subunit and alpha-hCG, and cross-reactivity with intact glycoprotein hormones (MRC standards of LH, FSH, hCG and TSH) were tested for their potential influence on the results of the assay. The basal levels of alpha-subunit were measured in 48 healthy young men, 48 normally menstruating women, 33 menopausal women, 37 pregnant women and 70 patients with pituitary adenoma. In addition a possibility of pulsatile secretion of alpha-subunit was investigated in 9 healthy young women, the ranges of alpha-subunit concentrations found were as follow (means +/- SD): 1.2 +/- 0.4 micrograms/l--in young men, 1.1 +/- 0.4 micrograms/l--in young women, 3.2 +/- 0.7 micrograms/l--in postmenopausal women, 1-54 micrograms/l--in pregnant women, and between 2.6 and 44.0 micrograms/l in 14 of 70 patients with pituitary adenoma. There were good correlations of results for 3 different antisera and their cross-reactivity with LH, FSH, hCG and TSH were just as low. In conclusion, the alpha-subunit assay appears clinically useful and should be widely applied in routine endocrinological diagnostics.