Maternal hyperthyroidism after intrauterine insemination due to hypertrophic action of human chorionic gonadotropin: a case report

PURPOSE OF INVESTIGATION

To report a rare case of maternal hyperthyroidism after intrauterine insemination due to hypertrophic action of hCG.

MATERIALS AND METHODS

A 36-year-old woman after successful intrauterine insemination and triplet pregnancy, developed hyperthyroidism with resistance to medical treatment.

RESULTS

All signs of hyperthyroidism resolved and the results of thyroid function tests returned to normal without any medication after embryo meiosis.

CONCLUSIONS

De novo maternal hyperthyroidism may develop during pregnancy as a result of pathological stimulation of the thyroid gland from the high levels of hCG hormone that can be seen in multiple pregnancies. The risk of hyperthyroidism is related to the number of fetuses. Reversibility of symptomatology can be seen after fetal reduction of multiple pregnancies.

Secondary hypoparathyroidism during pregnancy--a case report and review of the literature

Secondary hypoparathyroidism is seldom seen during pregnancy. Usually, it presents with hypocalcemia. Even if there is no established therapeutic treatment, vitamin D or its analogues are required. In the present case, a 36-year-old, second gravida, with known hypoparathyroidism for the last ten years, was admitted in the prenatal clinic of "Aretaieion" University Hospital in Athens at her 39 weeks of pregnancy. She was treated with calcitriol and calcium and she was monitored monthly. She had a cesarian section and delivered a healthy female baby of 3,380 gr at 39 weeks and 1 day.

Reactive oxygen species in the follicular fluid of subfertile women undergoing In Vitro Fertilization: a short narrative review

Reactive Oxygen Species (ROS) are produced as a normal product of aerobic metabolism. Naturally, there is an array of protective mechanisms that neutralize ROS, while any potential imbalance between ROS and antioxidants results in oxidative stress. In an In Vitro Fertilization (IVF) setting, existing literature suggests a favorable outcome in terms of oocyte quality/maturation and fertilization rate with increased ROS levels, while other study groups have presented significant data on the detrimental effect of increased ROS concentration in the quality of embryos exposed and their potential to advance. In this study, we examine the conflicting views of the role of ROS in fertilization and embryo quality, especially through their concentration in the follicular fluid of subfertile women undergoing IVF. The current debate could possibly be attributed to the different assay methods and end-point outcomes employed by each research group, along with the noted limited number of the relevant studies published on the subject. Properly conducted studies can further validate and elicit the exact role of ROS as well as their association to female reproduction, and especially to women undergoing IVF.

Tension-free vaginal tape obturator versus Ajust adjustable single incision sling procedure in women with urodynamic stress urinary incontinence

OBJECTIVE

To assess the efficacy and complications of inside-out transobturator tension-free vaginal tape (TVT-O) in comparison with a single incision sling procedure (Ajust) for the treatment of urodynamic stress urinary incontinence.

STUDY DESIGN

Prospective closely matched controlled study. In total, 171 patients were included in the study: 86 women underwent the TVT-O procedure, while in other 85 cases the Ajust procedure was performed. Subjective and objective cure, improvement and failure rates, mean operative time, hospital stay and incidence of complications were assessed.

RESULTS

There was no statistically significant difference between the two groups for age, body mass index, parity, menopausal status and severity of prolapse. No major intraoperative complications occurred. There was no significant difference in the mean operative time and the duration of hospital stay between the two groups. The mean follow-up time of the study was 22.3 months (range 12-36 months). For the TVT-O group the objective cure rate was 86%, the improvement rate was 5.9% and the failure rate was 8.1%, while the subjective cure rate was 82.6%. For the Ajust group the objective cure rate was 84.7%, the improvement rate was 4.7%, 10.6% of patients showed no change in their symptoms and the subjective cure rate was 81.2%.

CONCLUSIONS

The Ajust sling procedure presents success rates, at 22 months' mean follow up, comparable to the TVT-O method. Both techniques seem to be safe and effective for the treatment of urodynamic stress urinary incontinence.

Efficacy and safety of DT56a compared to hormone therapy in Greek post-menopausal women

BACKGROUND

Hormone therapy (HT) is the treatment of choice for the alleviation of menopausal symptoms; concerns, however, about its concomitant long-term health risks have limited its use. DT56a is a unique enzymatic isolate of soybeans. The purpose of our study was to evaluate the efficacy and safety of DT56a, compared to HT, in symptomatic post-menopausal women.

SUBJECTS AND METHODS

Eighty-nine post-menopausal women were studied prospectively. Women with climacteric symptoms were randomly assigned to receive eitherDT56a (no.=27) or oral low dose continuous combined HT (no.=26). Symptomatic women not wishing to receive any treatment served as controls (no.=36). Menopausal symptoms as assessed through the Kupperman index, serum lipids and lipoproteins, calcium, as well as bone mineral density (BMD), endometrial thickness, and mammography were assessed at baseline and at 12 months.

RESULTS

Patients receiving HT and DT56a showed a significant and independent decrease in menopausal symptoms (mean difference in Kupperman score, DT56a group: -3.98, HT group -5.601, no treatment group +1.76, p-value <0.001). Lumbar spine BMD T-score was significantly lower in women receiving no treatment, as opposed to the two treatment arms which showed no significant change (No treatment, baseline: -0.60, final: -0.85, p=0.001; HT, baseline: -84, final -0.99, p=0.79; DT56a, baseline -0.51, final: -0.76, p=0.75). No differences in femoral bone density, ET or mammography classification were detected in any of the treatment arms. Likewise, serum lipids or lipoproteins did not differ between the three groups.

CONCLUSIONS

DT56a decreased menopausal symptoms significantly and in the same degree as HT.

MTHFR C677T polymorphism modifies the effect of HRT on metabolic parameters in postmenopausal women

OBJECTIVE

To assess the interaction of the MTHFR C677T polymorphism with changes in lipid and glucose metabolism effected by oral hormone replacement therapy (HRT) in postmenopausal women.

METHODS

In this open-label, prospective, interventional study, parameters of lipid and glucose metabolism, as well as homocysteine, were assessed in 97 postmenopausal women at baseline and 1 year after the initiation of HRT. Participants were stratified into three subgroups, according to the MTHFR C677T polymorphism (wild-type: CC genotype; heterozygous: CT genotype; homozygous for the mutant variable: TT genotype).

RESULTS

The TT genotype was associated with an elevation of total and low density lipoprotein (LDL) cholesterol, while CT and CC genotypes were associated with a reduction of total cholesterol and LDL cholesterol after 1 year of HRT (p = 0.032 for total cholesterol and p = 0.002 for LDL cholesterol). Women with the TT genotype had higher glucose levels in contrast to women with the CC genotype who had lower glucose levels after 1 year of HRT (p = 0.011). Additionally, CC carriers under HRT had a significant elevation of apolipoprotein A1 levels (p = 0.018), contrarily to CT and TT genotypes.

CONCLUSION

While HRT was associated with favorable changes in lipid and metabolic parameters in carriers of the CC genotype, this effect was not evident in carriers of the T allele. The MTHFR C677T polymorphism may modify the effect of HRT on lipid and metabolic parameters in postmenopausal women.

Pathogenesis of endometriosis: the role of genetics, inflammation and oxidative stress

INTRODUCTION

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity.

MATERIALS AND METHODS

The etiology of this multifactorial disease is still unresolved and an increasing number of studies suggest that genetic, hormonal, environmental, immunological and oxidative factors may all play an important role in the pathogenesis of this disorder.

CONCLUSIONS

In this literature review, inflammatory activity, oxidative stress as well as genetic abnormalities and mutations have been studied in an effort to identify factors predisposing to endometriosis.

Does hormone therapy, tibolone or raloxifene modify VEGF expression in cervical epithelial cells?

AIM

Vascular endothelial growth factor (VEGF) seems to be a critical molecule in cervical carcinogenesis. We aimed to investigate the possible associations between hormonal factors and VEGF expression in cervical epithelial cells from postmenopausal women.

METHOD

A total of 105 healthy postmenopausal women (aged 45-68 years old) attending a university menopause clinic were enrolled in this cross-sectional study. Pap smears were derived from current users of 17β-estradiol 1 mg + norethisterone acetate 0.5 mg (n = 28), tibolone 2.5 mg (n = 23), raloxifene HCl 60 mg (n = 21) and women not receiving treatment (n = 33). VEGF immunostaining was evaluated in squamous, glandular and metaplastic cells, using a semiquantitative method (rating scale: 0-3).

RESULTS

Concerning endogenous hormones, higher Δ4-androstenedione levels were associated with more intense VEGF immunostaining in glandular (p = 0.041) and metaplastic cells (p = 0.004). Hormone therapy and raloxifene did not induce any changes in VEGF immunoreactivity in the examined cells. In contrast, tibolone administration was accompanied by diminished VEGF presence in metaplastic cells (p = 0.016 vs. controls).

CONCLUSION

Our findings may in part reflect the molecular processes contributing to the safe profile of hormone therapy, tibolone and raloxifene in cervical carcinogenesis.

The presence of CD40, CD40L and ADAM8 among endometriotic patients

Clinical and molecular research data are still insufficient to determine the onset, etiology and progression of endometriosis. Recently, a number of studies have been investigating the role of the inflammatory-immune factor. The role of inflammation in tissue infiltration and staging of endometriosis is limited. The aim of this study is to investigate the presence of CD40, CD40L and ADAM8 among endometriotic patients. These three markers of inflammation were measured in the serum of each of 76 women participating in the study. Twenty-nine (29) women, of mean age 36.9, (±9.2 SD) years free of endometriosis served as the control group. Of the endometriotic women 15 had a stage I-II and 32 stage III-IV disease. We undertook the present investigation expecting that an increased expression of CD40, CD40L and ADAM8 would testify to the inflammatory-autoimmune character of endometriosis. No difference in the levels of CD40, ADAM 8, CD40L was detected between the two groups. The stage of endometriosis did not affect CD40, ADAM 8, CD40L serum concentrations. A difficulty in our study is the lack of data with which to compare our results. Further investigation is needed to elucidate the role of these inflammatory markers in endometriosis.

The effect of hormone therapy and tibolone on serum CD40L and ADAM-8 in healthy post-menopausal women

BACKGROUND/AIM

The role of neutrophils and platelets in atherothrombotic disease is well established. The aim of our study was to investigate the effect of HT and tibolone on the soluble markers of neutrophil and platelet activation, "a disentigrin and metalloproteinase domain" (ADAM-8) and CD40 ligand (CD40L) respectively, in healthy post-menopausal women.

SUBJECTS AND METHODS

One hundred and six healthy post-menopausal women were randomly allocated to: estradiol plus drospirenone (E₂/DSP), E₂ hemihydrate 1 mg plus norethisterone acetate (E₂/NETA) 0.5 mg, and tibolone 2.5 mg. Serum ADAM-8 and CD40L were measured at baseline and at 6 months.

RESULTS

Baseline values of ADAM-8 and CD40L were similar between groups. No significant correlation was revealed between ADAM-8 or CD40L and parameters related to cardiovascular risk factors in each group. No significant changes were observed between baseline values and values at 6 months (E₂/DSP group: ADAM-8: 267.4±71.3 pg/ml vs 270.7±42.8 pg/ml, p=0.86, CD40L: 6.43±3.13 vs 6.79±2.70 ng/ml, p=0.67), (E₂/NETA group: ADAM-8: 308.3±64.3 vs 294.7±57.7 pg/ml, p=0.40, CD40L: 9.68±2.81 vs 8.59±5.13 ng/ml, p=0.51), (tibolone group: ADAM-8: 307.5±87.5 vs 289±48.1 pg/ml, p=0.48, CD40L: 9.46±4.30 vs 9.26±4.60 ng/ml, p=0.99).

CONCLUSIONS

Our study has not revealed an association between estrogen plus progestin treatment or tibolone on serum ADAM-8 and CD40L levels in healthy post-menopausal women. Larger prospective studies are needed to further investigate the effect of low-dose HT or tibolone on serum markers of neutrophil and platelet activation.