Plasma androstenedione and oestrone levels before and after the menopause. I. Glandular hyperplasia and adenocarcinoma of the endometrium

Case-control study of endogenous sex steroid hormones and risk of endometrial cancer

BACKGROUND

Epidemiologic evidence regarding the role of endogenous sex hormones in endometrial cancer etiology remains inconsistent. The objective of this study was to investigate if circulating levels of endogenous estrone, estradiol, sex hormone binding globulin (SHBG), testosterone, and androstenedione are associated with endometrial cancer risk.

METHODS

We conducted a population-based case-control study of 522 incident endometrial cancer cases and 976 population controls, in Alberta, Canada from 2002 to 2006. Study participants completed in-person interviews and provided fasting blood samples. Sex hormone levels were determined by enzyme-linked immunosorbent assays.

RESULTS

Higher levels of androstenedione were associated with increased endometrial cancer risk (OR 1.44, 95% CI 1.04-2.02). Endometrial cancer risk in pre- and peri-menopausal women was reduced for the highest versus lowest quartiles of estrone (OR 0.44, 95% CI 0.22-0.88) and estradiol (OR 0.30, 95% CI 0.14-0.65), but in post-menopausal women, the endometrial cancer risk was increased for the highest versus lowest quartile of androstenedione (OR 1.82, 95% CI 1.25-2.65). In addition, endometrial cancer risk in normal/underweight women was decreased for the highest versus lowest quartile of serum SHBG (OR 0.39, 95% CI 0.19-0.84).

CONCLUSIONS

Overall, positive associations were found for androstenedione concentrations, while sub-group analyses revealed = inverse associations with estrogens and SHBG. Results of this study provide empirical evidence for the role of circulating sex hormones in endometrial cancer etiology and highlight the importance of modifiable factors that contribute to changes in sex hormone concentration levels.

Histopathological findings in women with postmenopausal bleeding

OBJECTIVE

To investigate endometrial histopathology in a geographically defined population of women presenting with postmenopausal bleeding.

DESIGN

Prospective study with collection of data during an 18-month period.

SETTING

The health care county of Skaraborg, Sweden.

SUBJECTS

Dilatation and curettage using general anaesthesia was performed on 457 postmenopausal women suffering from uterine bleeding. Women using hormone replacement therapy for climacteric complaints were not included in the investigation.

MAIN OUTCOME MEASURES

The frequency of bleeding was correlated to endometrial histopathology, and in relevant cases to pathological conditions in cervix and ovaries in a defined population of postmenopausal women.

RESULTS

The incidence of postmenopausal bleeding decreased with increasing age while the probability of cancer as the underlying cause increased. The peak incidence of endometrial carcinoma was found in women between 65 and 69 years of age. Endometrial histopathology showed: atrophy (50%); proliferation (4%); secretion (1%); polyps (9%); different degrees of hyperplasia (10%); adenocarcinoma (8%); not representative (14%); other disorders (3%). In six women a squamous carcinoma of the cervix was found, and eight proved to have ovarian tumours.

CONCLUSIONS

The histopathological finding of endometrial adenomatous hyperplasia or cancer in about 15% of the postmenopausal women with bleeding justifies a thorough examination. The probability of cancer as the underlying cause increased with age. The endometrium was atrophic in 50%. Eight women had ovarian tumours. These findings may imply that transvaginal ultrasound examination should be included in the evaluation of postmenopausal bleeding as occasionally endometrial biopsies of atrophic endometrium could be avoided and ovarian pathology detected.

Gonadotrophin response to releasing hormone in post-menopausal patients with ovarian tumours

Gonadotrophin response to intravenous administration of 100 micrograms synthetic gonadotrophin-releasing hormone (GnRH) was evaluated in 14 post-menopausal women (aged 53-77) with non-endocrine ovarian tumours and 11 post-menopausal control subjects. Neither in the case of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, was any significant difference seen between the mean basal levels in the tumour and the control subjects. No significant release was seen in either group as regards FSH response. The mean increases in serum FSH in the tumour patients were not significantly different from those in the control subjects. In the case of LH response, the mean percentage increases in the tumour group as well as the mean area under the curves were significantly greater (P less than 0.01) than those in the control subjects. Androstenedione and oestrone levels were also evaluated in the two groups. Significantly increased levels of these hormones were seen in the tumour group in relation to those in the control group (P less than 0.001). These data are consistent with an increased LH response to GnRH in post-menopausal patients with ovarian tumours. The augmented LH release may be related to increased steroid plasma levels.

Diagnostic significance of steroid hormones in patients with ovarian cancer

One hundred and fourteen pre- and postmenopausal patients with nonendocrine tumors or simple cysts of the ovary were studied. These patients had androstenedione (A) plasma levels determined preoperatively. Some of these subjects had estrone (E1) and 17 beta-estradiol (E2) determinations also. Of the tumor patients, 58 had also measured the postoperative steroid levels. The results were compared with the hormone levels found in 188 normal women, who were of similar weight and reproductive status. Significantly increased (p less than 0.001) A, E1 and E2 plasma concentrations were found in postmenopausal patients with nonfunctioning tumors. In the tumor patients before the menopause, the levels of A were significantly elevated (p less than 0.001). In the patients with simple cysts, these steroid levels were within the normal range. Following ovariectomy, the decrease of plasma A suggested that the origin of the high levels of this steroid was the ovary where the neoplasm resided. For possible diagnostic purposes, both A and E1 abnormal test results showed adequate sensitivity and good specificity to permit detection of ovarian carcinoma after the menopause. Plasma levels of A were partially related to the histological types and FIGO Stages of the tumor.

Androstenedione, 17 beta-estradiol and progesterone plasma levels in gonadotropins induction of ovulation

A comparison of peripheral patterns of androstenedione (A), 17 beta-estradiol (E2) and progesterone (P) is reported in ten infertile women during HMG-HCG induction of ovulation, in order to assess the site of ovarian secretion of plasma A and the possible influence on conception. Evidence for both the follicular and luteal secretion of plasma A is suggested, in addition to the stromal and adrenal contributions, since a highly significant (p less than 0.001) correlation between A and E2 plasma levels was shown during the treatment. In three cycles of conception, plasma A showed a periovulatory peak and drop, followed by a luteal increase, all of which are characteristic of E2.

Plasma androstenedione and oestrone levels in the climacteric syndrome

Plasma androstenedione (A) and oestrone (E1) levels were measured by radioimmunoassay in a group of 78 healthy women who had undergone a natural menopause. Of this total, 23 were symptomless (Group 1), 39 presented with a moderate climacteric syndrome (Group 2) and 16 had a severe climacteric syndrome (Group 3). The average body weight was found to be significantly higher in Groups 2 (P less than 0.01) and 3 (P less than 0.05), than in Group 1, but the age distribution and number of years since the menopause were similar in all three groups. Nevertheless, significantly lower levels of A (0.75 +/- 0.06 ng/ml, P less than 0.01, in Group 2; 0.24 +/- 0.05 ng/ml, P less than 0.001, in Group 3) and E1 (20.80 +/- 2.18 pg/ml, P less than 0.05, in Group 2; 12.22 +/- 1.65 pg/ml, P less than 0.001, in Group 3) were observed in the women with climacteric symptoms than in those with no symptoms (A = 1.08 +/- 0.08 ng/ml, E1 = 27.73 +/- 2.22 pg/ml in Group 1). Since, after the menopause, the concentrations of A and E1 in the plasma represent the most important source of oestrogens, these results suggest that climacteric symptoms are related to oestrogen deficiency which is secondary to low A production.

Plasma androstenedione and oestrone levels before and after the menopause. II. Non-endocrine ovarian tumours and cysts

Plasma androstenedione (A) and oestrone (E1) levels were measured by radioimmunoassay in 45 hospitalized patients who had non-endocrine benign or malignant ovarian tumours or cysts. The findings of these measurements were compared with the findings of the mean steroid levels which we determined previously (see previous article) in 135 healthy women, around the menopause, of similar weight. Of the total number of patients, 26 had non-endocrine benign ovarian tumours and cysts and were in the reproductive and pre-menopausal ages. The mean plasma A level was found to be significantly higher than the normal value (P less than 0.001). However, the plasma E1 level was not different from the norm. The remaining 19 patients, all around the menopause, had non-endocrine malignant epithelial ovarian tumours. The mean plasma levels of both A and E1 were found to be significantly higher (P less than 0.001) than the normal values. Since increased plasma A levels are associated with non-endocrine ovarian tumours and cysts, it seems likely that the measurement of plasma A may be used as an endocrine detector of non-endocrine ovarian tumours.