1
|
García-Alonso M, Corral-Gudino L. High prevalence of stress fractures and long-term amenorrhoea in high endurance female athletes: The misleading lack of correlation with bone mineral density. J Orthop 2024; 55:109-113. [PMID: 38681828 PMCID: PMC11047200 DOI: 10.1016/j.jor.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024] Open
Abstract
Aim & objectives Females who engage in high levels of sports have a high prevalence of menstrual cycle disorders and bone stress injuries (BSI). In this study, we determined the prevalence of menstrual disorders and fractures in female athletes and their association with bone mineral density (BMD) parameters. Material & methods Cross-Sectional Study. Forty-one female athletes from a public High-Performance Regional Centre; 24 high-endurance athletes (HEA) and 17 other athletes, were included. To form the control group, we invited medical students from a public University. Twenty-nine non-athletes (NA) were included. A health surveys and a dual-energy X-ray absorptiometry (DXA) were conducted for all participants. Results Among the participants (median age, 24 years; body mass index, 21 kg/m2), the percentage of long-term amenorrhoea was 42 % in HEA vs. 0 % in NHEA (OR 25.35; 95 % CI 1.37-470.50, p = 0.008) or 10 % in NA (OR 6.20; 95 % CI 1.46-26.24, p = 0.022), and the percentage of BSI was 29 % in HEA vs. 0 % in NHEA or NA. Both groups of female athletes (HEA and NHEA) showed higher Z-scores than those of NA in the femur; however, only NHEA had a significant increase in the BMD on lumbar spine than that of NA. Conclusion The prevalence of long-term amenorrhoea and/or BSI was significantly higher in the HEA than in the NHEA or NA females. In contrast, HEA, like NHEA, had higher BMD values in the femur than those of controls. It is unlikely that DXA parameters can be used to estimate cortical BSI risk in this population.
Collapse
Affiliation(s)
- M. García-Alonso
- Department of Medicine, Dermatology and Toxicology. School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - L. Corral-Gudino
- Department of Medicine, Dermatology and Toxicology. School of Medicine, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| |
Collapse
|
2
|
Agrawal P, Garg R, Agrawal M, Singh MK, Verma U, Chauhan R. Sheehan's Syndrome in India: Clinical Characteristics and Laboratory Evaluation. J Obstet Gynaecol India 2023; 73:51-55. [PMID: 37916020 PMCID: PMC10616000 DOI: 10.1007/s13224-023-01801-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background Sheehan's Syndrome (SS) is an important cause of hypopituitarism especially in developing countries though it remains underdiagnosed to a great extent. Torrential bleeding after delivery followed by lactation failure and amenorrhoea gives a clue to the diagnosis which is usually made after several years of delivery. Materials and Methods It was a retrospective observational study conducted by reviewing the case records of 38 cases of SS. The age, anthropometric measurements, signs and symptoms, biochemical parameters, hormone levels and imaging reports were examined and analyzed. Results The mean age at presentation was 36.5 years because there was a delay of 8.4 years from last delivery before diagnosis could be made. Ninety percent patients presented with lactation failure. Anaemia, hypotension, hypogonadism, hypothyroidism, and altered lipid profile were the most common findings. The mean systolic blood pressure (BP) was 80.95 mm and diastolic BP was 51.6 mm of Hg at the time of presentation. Hyponatremia was the most common electrolyte abnormality noted and low HDL was the commonest lipid abnormality. Conclusion A large percentage of patients presented with amenorrhea, lactation failure, and decreased or absent axillary/pubic hair. Shock, anemia, and hyponatremia were also common symptoms among the patients studied. The diagnosis of SS rests upon a thorough history taking of the postpartum events in cases presenting with hypopituitarism irrespective of the age at presentation. Proper antenatal care with exclusive institutional deliveries can reduce the prevalence of SS in developing countries.
Collapse
Affiliation(s)
| | - Ruchika Garg
- Department of Obs and Gynaecology, SN Medical College, Agra, India
| | - Mohita Agrawal
- Department of Obs and Gynaecology, SN Medical College, Agra, India
| | | | - Urvashi Verma
- Department of Obs and Gynaecology, SN Medical College, Agra, India
| | - Richa Chauhan
- Department of Obs and Gynaecology, SN Medical College, Agra, India
| |
Collapse
|
3
|
Murray Hurtado M, Martín Rivada Á, Quintero Alemán C, Ruiz Alcántara MP, Ramallo Fariña Y. Body composition and nutritional status changes in adolescents with anorexia nervosa. An Pediatr (Barc) 2023; 99:162-169. [PMID: 37563070 DOI: 10.1016/j.anpede.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Nutritional status assessment in anorexia nervosa (AN) includes the evaluation and monitoring of body composition throughout the treatment period. The gold standard for the study of body composition is dual-energy X-ray absorptiometry (DEXA), although electrical bioimpedance (BIA) is a more accessible, cheaper and faster method that does not involve exposure to radiation. MATERIAL AND METHODS We recruited 33 female adolescents with AN (age, 11.7-16.3 years) by consecutive sampling. We collected data on clinical, anthropometric and laboratory variables. Patients were assessed with BIA and DEXA at inclusion in the study and at the end of the study, with a mean duration of follow-up of 1 year, during the nutritional rehabilitation phase. RESULTS There was significant improvement in nutritional status, reflected by the body composition obtained by anthropometric measurements and BIA. The phase angle increased significantly during the follow-up. Greater weight loss was associated with the presence of secondary amenorrhoea and decreased bone mineral density in the spine. CONCLUSIONS Electrical BIA is a useful tool for assessment and monitoring of nutritional status in paediatric patients with AN. Dual-energy X-ray absorptiometry continues to be essential to assess bone mineral density. The role of hormones such as leptin remains to be elucidated.
Collapse
Affiliation(s)
- Mercedes Murray Hurtado
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
| | - Álvaro Martín Rivada
- Sección Nutrición y Errores Innatos del Metabolismo, Complejo Hospitalario Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | | | | | - Yolanda Ramallo Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Colegio Oficial de Médicos de Tenerife, Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Santa Cruz de Tenerife, Spain
| |
Collapse
|
4
|
Whitaker LH, Middleton LJ, Daniels JP, Williams AR, Priest L, Odedra S, Cheed V, Stubbs CE, Clark TJ, Lumsden MA, Hapangama DK, Bhattacharya S, Smith PP, Nicholls EP, Roberts N, Semple SI, Saraswat L, Walker J, Chodankar RR, Critchley HO. Ulipristal acetate versus levonorgestrel-releasing intrauterine system for heavy menstrual bleeding (UCON): a randomised controlled phase III trial. EClinicalMedicine 2023; 60:101995. [PMID: 37251622 PMCID: PMC10209678 DOI: 10.1016/j.eclinm.2023.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Background Heavy menstrual bleeding affects one in four women and negatively impacts quality of life. Ulipristal acetate is prescribed to treat symptoms associated with uterine fibroids. We compared the effectiveness of ulipristal acetate and the levonorgestrel-releasing intrauterine system at reducing the burden of heavy menstrual bleeding, irrespective of the presence of fibroids. Methods This randomised, open-label, parallel group phase III trial enrolled women over 18 years with heavy menstrual bleeding from 10 UK hospitals. Participants were centrally randomised, in a 1:1 ratio, to either three, 12-week treatment cycles of 5 mg ulipristal acetate daily, separated by 4-week treatment-free intervals, or a levonorgestrel-releasing intrauterine system. The primary outcome, analysed by intention-to-treat, was quality of life measured by the Menorrhagia Multi-Attribute Scale at 12 months. Secondary outcomes included menstrual bleeding and liver function. The trial is registered with ISRCTN, 20426843. Findings Between June 5th, 2015 and February 26th, 2020, 236 women were randomised, either side of a recruitment suspension due to concerns of ulipristal acetate hepatoxicity. Subsequent withdrawal of ulipristal acetate led to early cessation of recruitment but the trial continued in follow-up. The primary outcome substantially improved in both groups, and was 89, (interquartile range [IQR] 65 to 100, n = 53) and 94, (IQR 70 to 100, n = 50; adjusted odds ratio 0.55, 95% confidence interval [CI] 0.26-1.17; p = 0.12) in the ulipristal and levonorgestrel-releasing intrauterine system groups. Rates of amenorrhoea at 12 months were higher in those allocated ulipristal acetate compared to levonorgestrel-releasing intrauterine system (64% versus 25%, adjusted odds ratio 7.12, 95% CI 2.29-22.2). Other outcomes were similar between the two groups and there were no cases of endometrial malignancy or hepatotoxicity due to ulipristal acetate use. Interpretation Our findings suggested that both treatments improved quality of life. Ulipristal was more effective at inducing amenorrhoea. Ulipristal has been demonstrated to be an effective medical therapeutic option but currently its use has restrictions and requires liver function monitoring. Funding UK Medical Research Council and National Institute of Health Research EME Programme (12/206/52).
Collapse
Affiliation(s)
- Lucy H.R. Whitaker
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Lee J. Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Jane P. Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Lee Priest
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Smita Odedra
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Versha Cheed
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Clive E. Stubbs
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Mary-Ann Lumsden
- Reproductive & Maternal Medicine, University of Glasgow, Glasgow, UK
| | - Dharani K. Hapangama
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | - Paul P. Smith
- Birmingham Women's and Children's Hospital, Birmingham, UK
| | | | - Neil Roberts
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Scott I. Semple
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Jane Walker
- Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rohan R. Chodankar
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - UCON Collaborative
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
- Division of Pathology, University of Edinburgh, Edinburgh, UK
- Birmingham Women's and Children's Hospital, Birmingham, UK
- Reproductive & Maternal Medicine, University of Glasgow, Glasgow, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- University of Aberdeen, Aberdeen, UK
- Adcal H.R. Consultancy, UK (PPI representative)
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Department of Clinical Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Watson C. The care of patients with secondary hypothalamic amenorrhoea. Br J Nurs 2023; 32:240-244. [PMID: 36913335 DOI: 10.12968/bjon.2023.32.5.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Secondary hypothalamic amenorrhoea is a common menstrual disorder affecting women of reproductive age. In some cases, periods become absent due to prolonged stress on the body, caused by undereating, overexercising and psychological stress. Secondary hypothalamic amenorrhoea is often underdiagnosed and undertreated, and patients may be prescribed oral contraception, which can mask the problem. This article will mainly focus on lifestyle factors associated with this condition and its association with disordered eating.
Collapse
Affiliation(s)
- Chloe Watson
- Staff Nurse, Paediatric and Adolescent Oncology, Great North Children's Hospital, Newcastle upon Tyne
| |
Collapse
|
6
|
Mahey R, Rana A, Cheluvaraju R, Vyas S, Raj R, Bhatla N. An unusual association of type II Mayer-Rokitansky-Kuster-Hauser syndrome, turner mosaic syndrome and tubo-ovarian inguinal hernia- case report and review of literature. J Ovarian Res 2023; 16:43. [PMID: 36814312 PMCID: PMC9948362 DOI: 10.1186/s13048-022-01067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/28/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Herniation of ovaries and Mullerian structures into inguinal canal is usually reported in infants and is rare among adults. We are presenting a rare case of Mullerian agenesis and Turner mosaic syndrome with tubo-ovarian inguinal hernia. CASE PRESENTATION A 17-year-old girl presented with complaints of primary amenorrhea, phenotypical features of Turner syndrome with left inguinal hernia and severe hypertension. Baseline hormonal analysis was normal. Karyotype revealed Turner mosaic with 46XX (85%); 45XO (15%). MRI showed Mullerian agenesis with normally located right ovary in pelvis and left ovary prolapsed through deep inguinal ring into the canal of Nuck. Anti-hypertensives were started and patient optimized for surgery. Laparoscopic hernia repair and repositioning of left ovary into the pelvis was done. Patient had uneventful post-operative course and was discharged in stable condition on anti-hypertensive medication. Future reproductive issues and need of passive vaginal dilatation or vaginoplasty before marriage were explained to the patient and family. CONCLUSION This is the first ever reported case with unusual association of atypical MRKH, Turner mosaic syndrome and tubo-ovarian hernia into the inguinal canal. The case emphasizes the need and importance of complete work up of these atypical cases as patients may have more than one cause of primary amenorrhea and complete evaluation is must before any medical or surgical intervention.
Collapse
Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India.
| | - Anubhuti Rana
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Rohitha Cheluvaraju
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Surabhi Vyas
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Ritu Raj
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Neerja Bhatla
- grid.413618.90000 0004 1767 6103Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| |
Collapse
|
7
|
Bastianelli C, Grandi G, Farris M, Brandolino G, Paoni Saccone G, La Barbiera I, Benagiano G. Attitudes towards menstruation: what women want? An Italian National Survey. EUR J CONTRACEP REPR 2023; 28:28-35. [PMID: 36318831 DOI: 10.1080/13625187.2022.2130686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Many women experience negative feelings during menstrual bleeding. Aim of the study was to evaluate the attitudes of Italian women towards menstrual bleeding, their desire to reduce its frequency and knowledge of the existence of methods capable of achieving such an objective. METHODS An internet-based anonymous questionnaire has been sent to women willing to fill it in through different social media (Instagram, WhatsApp, Facebook, Twitter). The survey evaluated, objective parameters such as number of pads, use of painkillers, duration of period and pain intensity. Judgement towards period and knowledge about methods to reduce frequency and amount of menstrual flow were analysed. RESULT 1072 Women aged 18 - 40 years, answered the survey. The level of education of responders was high, with 61.7% having a university degree. 27.5% of respondents viewed positively the occurrence of a menstrual period. Ideal frequency of menstrual cycles was considered 3 months and the perfect duration was considered to be 3 days. Half of the respondents ignored the existence of methods to suppress menstruation or reduce its frequency. 52% of participants stated that they would not use a contraceptive method because they considered it not 'natural'. CONCLUSIONS In our sample, in spite of the discomfort reported by half of the women interviewed, menstruation was considered positively by one fourth as because confirm their fertility. The majority of women did consider bleeding every month a healthy, but they preferred a three-monthly frequency. Knowledge of contraceptive methods capable of reducing the frequency of menstrual bleeding was scarce.
Collapse
Affiliation(s)
- Carlo Bastianelli
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Gabriella Brandolino
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giulia Paoni Saccone
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Ilenia La Barbiera
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| | - Giuseppe Benagiano
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Rome, Italy
| |
Collapse
|
8
|
Lopes MP, Robinson L, Stubbs B, Dos Santos Alvarenga M, Araújo Martini L, Campbell IC, Schmidt U. Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis. J Eat Disord 2022; 10:173. [PMID: 36401318 PMCID: PMC9675098 DOI: 10.1186/s40337-022-00694-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD. PURPOSE To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC). METHODS Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use). RESULTS Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD. CONCLUSION Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.
Collapse
Affiliation(s)
- Mariana P Lopes
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil. .,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Brendon Stubbs
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Marle Dos Santos Alvarenga
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Ligia Araújo Martini
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| |
Collapse
|
9
|
Kounidas G, Kastora SL, Barnott E, Black L, Robinson-Burke T, Gould A, Morgan D, Urquhart G, Poobalan A, Jack A. Efficacy of ulipristal acetate in women with fibroid induced menorrhagia: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2021; 50:102173. [PMID: 34082168 DOI: 10.1016/j.jogoh.2021.102173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the efficacy of UPA in women with fibroid induced menorrhagia. METHODS Embase, MEDLINE, CAB Abstracts, Cochrane Central Register of Controlled Trials, PsychInfo were searched up to 18th May 2020 and updated on 7th February 2021. Randomised controlled trials evaluating the efficacy of UPA in women with fibroid induced menorrhagia were included in the study. RESULTS Two authors independently reviewed and extracted the study data. Statistical heterogeneity was quantified using I2 statistics. Publication bias and data asymmetry was assessed by funnel plots. A meta-analysis was conducted where appropriate. Six studies were eligible for inclusion. UPA (5 mg and 10 mg) achieved statistically significant amenorrhoeic outcome when compared to placebo (p<0.00001). Increased adverse events (AE) profile was observed in the higher UPA dose, however, did not reach statistical significance. CONCLUSIONS This review demonstrates the efficacy of UPA in achieving amenorrhoea in women with fibroid induced menorrhagia. However, the favourable dose of UPA remains inconclusive when AE profile is taken into account. Evidence remains obscure regarding liver damage and further research is warranted to attain a conclusive outcome.
Collapse
Affiliation(s)
- Georgios Kounidas
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD.
| | - Stavroula Lila Kastora
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Emma Barnott
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Lydia Black
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Tamara Robinson-Burke
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Alexandra Gould
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Dale Morgan
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Grace Urquhart
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Amudha Poobalan
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Alison Jack
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| |
Collapse
|
10
|
Turnbull AK, Patel S, Martinez-Perez C, Rigg A, Oikonomidou O. Risk of chemotherapy-related amenorrhoea (CRA) in premenopausal women undergoing chemotherapy for early stage breast cancer. Breast Cancer Res Treat 2021; 186:237-45. [PMID: 33047206 DOI: 10.1007/s10549-020-05951-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/23/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE While chemotherapy has improved survival among younger women with breast cancer, it can induce temporary or permanent chemotherapy-related amenorrhoea (CRA), impacting survival benefit, quality of life and, importantly for younger patients, fertility. METHODS This single institution retrospective study of 107 premenopausal women with early stage breast cancer who received neoadjuvant or adjuvant combined chemotherapy treatment investigates the association of clinicopathological factors (including age-related, gynaecological and tumour-related variables) with CRA and resumption of menses using generalised linear models for univariable and multivariate analyses. RESULTS 76% of women developed CRA, of which only 40% resumed menses after treatment. Age at time of treatment and at menarche were significantly associated with CRA incidence, with higher rates linked to older age (≥ 40 years) and later menarche (at ≥ 13 years), in both univariable (P = 0.043 and P = 0.009, respectively) and multivariate (P = 0.010 and P = 0.012, respectively) analyses. Age at time of treatment, age at menarche and use of tamoxifen were significantly associated with resumption of menses (with greater resumption rates linked to younger age (< 40 years old), later menarche (≥ 13 years old) or no tamoxifen use status), in both univariable (P < 0.0001, P = 0.002 and P = 0.039, respectively) and multivariate (P = 0.001, P = 0.011 and P = 0.008, respectively) analyses. Menses resumption rates were also significantly higher (P = 0.015) in women with later cessation of menses (after 3-6 chemotherapy cycles rather than sooner). CONCLUSIONS Age at menarche and, specially, at time of treatment are important risk factors for CRA. These variables could aid decision-making for treatment selection and fertility preservation among premenopausal women with early breast cancer.
Collapse
|
11
|
Livadas S, Androulakis I, Angelopoulos N, Lytras A, Papagiannopoulos F, Kassi G. Liraglutide administration improves hormonal/metabolic profile and reproductive features in women with HAIR-AN syndrome. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190150. [PMID: 32554829 PMCID: PMC7354729 DOI: 10.1530/edm-19-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/15/2020] [Indexed: 12/22/2022] Open
Abstract
SUMMARY HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance (IR) and Acanthosis Nigricans, constitutes a rare nosologic entity. It is characterized from clinical and biochemical hyperandrogenism accompanied with severe insulin resistance, chronic anovulation and metabolic abnormalities. Literally, HAIR-AN represents an extreme case of polycystic ovary syndrome (PCOS). In everyday practice, the management of HAIR-AN constitutes a therapeutic challenge with the available pharmaceutical agents. Specifically, the degree of IR cannot be significantly ameliorated with metformin administration, whereas oral contraceptives chronic administration is associated with worsening of metabolic profile. Liraglutide and exenatide, in combination with metformin, have been introduced in the management of significantly obese women with PCOS with satisfactory results. Based on this notion, we prescribed liraglutide in five women with HAIR-AN. In all participants a significant improvement regarding the degree of IR, fat depositions, androgen levels and the pattern of menstrual cycle was observed, with minimal weight loss. Furthermore, one woman became pregnant during liraglutide treatment giving birth to a healthy child. Accordingly, we conclude that liraglutide constitutes an effective alternative in the management of women with HAIR-AN. LEARNING POINTS HAIR-AN management is challenging and classic therapeutic regimens are ineffective. Literally HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance and Acanthosis Nigricans, represents an extreme case of polycystic ovary syndrome. In cases of HAIR-AN, liraglutide constitutes an effective and safe choice.
Collapse
Affiliation(s)
- S Livadas
- Endocrine Unit, Metropolitan Hospital, Athens, Greece
| | - I Androulakis
- Endocrine Unit, Metropolitan Hospital, Athens, Greece
| | | | - A Lytras
- Endocrine Unit, Metropolitan Hospital, Athens, Greece
| | | | - G Kassi
- Endocrine Unit, Alexandra Hospital, Athens, Greece
| |
Collapse
|
12
|
Wurth R, Kamilaris C, Nilubol N, Sadowski SM, Berthon A, Quezado MM, Faucz FR, Stratakis CA, Hannah-Shmouni F. Inhibin A as a tumor marker for primary bilateral macronodular adrenal hyperplasia. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200006. [PMID: 32478669 PMCID: PMC7219132 DOI: 10.1530/edm-20-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Primary bilateral macronodular adrenal hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing syndrome (CS). This condition is characterized by glucocorticoid and/or mineralocorticoid excess, and is commonly regulated by aberrant G-protein coupled receptor expression may be subclinical, allowing the disease to progress for years undetected. Inhibin A is a glycoprotein hormone and tumor marker produced by certain endocrine glands including the adrenal cortex, which has not been previously investigated as a potential tumor marker for PBMAH. In the present report, serum inhibin A levels were evaluated in three patients with PBMAH before and after adrenalectomy. In all cases, serum inhibin A was elevated preoperatively and subsequently fell within the normal range after adrenalectomy. Additionally, adrenal tissues stained positive for inhibin A. We conclude that serum inhibin A levels may be a potential tumor marker for PBMAH. LEARNING POINTS PBMAH is a rare cause of CS. PBMAH may have an insidious presentation, allowing the disease to progress for years prior to diagnosis. Inhibin A is a heterodimeric glycoprotein hormone expressed in the gonads and adrenal cortex. Inhibin A serum concentrations are elevated in some patients with PBMAH, suggesting the potential use of this hormone as a tumor marker. Further exploration of serum inhibin A concentration, as it relates to PBMAH disease progression, is warranted to determine if this hormone could serve as an early detection marker and/or predictor of successful surgical treatment.
Collapse
Affiliation(s)
- Rachel Wurth
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Crystal Kamilaris
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Naris Nilubol
- Surgical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Samira M Sadowski
- Surgical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Annabel Berthon
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Martha M Quezado
- Laboratory of Pathology Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Fabio R Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Constantine A Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Fady Hannah-Shmouni
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| |
Collapse
|
13
|
Akinci B, Meral R, Rus D, Hench R, Neidert AH, DiPaola F, Westerhoff M, Taylor SI, Oral EA. The complicated clinical course in a case of atypical lipodystrophy after development of neutralizing antibody to metreleptin: treatment with setmelanotide. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190139. [PMID: 32213649 PMCID: PMC7159256 DOI: 10.1530/edm-19-0139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
SUMMARY A patient with atypical partial lipodystrophy who had a transient initial response to metreleptin experienced acute worsening of her metabolic state when neutralizing antibodies against metreleptin appeared. Because her metabolic status continued to deteriorate, a therapeutic trial with melanocortin-4 receptor agonist setmelanotide, that is believed to function downstream from leptin receptor in the leptin signaling system, was undertaken in an effort to improve her metabolic status for the first time in a patient with lipodystrophy. To achieve this, a compassionate use (investigational new drug application; IND) was initiated (NCT03262610). Glucose control, body fat by dual-energy X-ray absorptiometry and MRI, and liver fat by proton density fat fraction were monitored. Daily hunger scores were assessed by patient filled questionnaires. Although there was a slight decrease in hunger scales and visceral fat, stimulating melanocortin-4 receptor by setmelanotide did not result in any other metabolic benefit such as improvement of hypertriglyceridemia or diabetes control as desired. Targeting melanocortin-4 receptor to regulate energy metabolism in this setting was not sufficient to obtain a significant metabolic benefit. However, complex features of our case make it difficult to generalize these observations to all cases of lipodystrophy. It is still possible that melanocortin-4 receptor agonistic action may offer some therapeutic benefits in leptin-deficient patients. LEARNING POINTS A patient with atypical lipodystrophy with an initial benefit with metreleptin therapy developed neutralizing antibodies to metreleptin (Nab-leptin), which led to substantial worsening in metabolic control. The neutralizing activity in her serum persisted for longer than 3 years. Whether the worsening in her metabolic state was truly caused by the development of Nab-leptin cannot be fully ascertained, but there was a temporal relationship. The experience noted in our patient at least raises the possibility for concern for substantial metabolic worsening upon emergence and persistence of Nab-leptin. Further studies of cases where Nab-leptin is detected and better assay systems to detect and characterize Nab-leptin are needed. The use of setmelanotide, a selective MC4R agonist targeting specific neurons downstream from the leptin receptor activation, was not effective in restoring metabolic control in this complex patient with presumed diminished leptin action due to Nab-leptin. Although stimulating the MC4R pathway was not sufficient to obtain a significant metabolic benefit in lowering triglycerides and helping with her insulin resistance as was noted with metreleptin earlier, there was a mild reduction in reported food intake and appetite. Complex features of our case make it difficult to generalize our observation to all leptin-deficient patients. It is possible that some leptin-deficient patients (especially those who need primarily control of food intake) may still theoretically benefit from MC4R agonistic action, and further studies in carefully selected patients may help to tease out the differential pathways of metabolic regulation by the complex network of leptin signaling system.
Collapse
Affiliation(s)
- Baris Akinci
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
- Division of Endocrinology and Metabolism, Dokuz Eylul University, Izmir, Turkey
| | - Rasimcan Meral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Diana Rus
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Rita Hench
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam H Neidert
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank DiPaola
- Division of Pediatric Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Maria Westerhoff
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Simeon I Taylor
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elif A Oral
- Brehm Center for Diabetes Research and Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
14
|
Thewjitcharoen Y, Veerasomboonsin V, Nakasatien S, Krittiyawong S, Himathongkam T. Misdiagnosis of Mullerian agenesis in a patient with 46, XX gonadal dysgenesis: a missed opportunity for prevention of osteoporosis. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190122. [PMID: 31809259 PMCID: PMC6935711 DOI: 10.1530/edm-19-0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022] Open
Abstract
SUMMARY Primary amenorrhea could be caused by disorders of four parts: disorders of the outflow tract, disorders of the ovary, disorders of the anterior pituitary, and disorders of hypothalamus. Delay in diagnosis and hormone substitution therapy causes secondary osteoporosis. Herein, we report a case of a 23-year-old phenotypical female who presented with primary amenorrhea from 46, XX gonadal dysgenesis but had been misdiagnosed as Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome or Mullerian agenesis. The coexistence of gonadal dysgenesis and MRKH was suspected after laboratory and imaging investigations. However, the vanishing uterus reappeared after 18 months of hormone replacement therapy. Therefore, hormone profiles and karyotype should be thoroughly investigated to distinguish MRKH syndrome from other disorders of sex development (DSD). Double diagnosis of DSD is extremely rare and periodic evaluation should be reassessed. This case highlights the presence of estrogen deficiency state, the uterus may remain invisible until adequate exposure to exogenous estrogen. LEARNING POINTS An early diagnosis of disorders of sex development (DSD) is extremely important in order to promptly begin treatment, provide emotional support to the patient and reduce the risks of associated complications. Hormone profiles and karyotype should be investigated in all cases of the presumptive diagnosis of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome or Mullerian agenesis. The association between 46, XX gonadal dysgenesis and Mullerian agenesis has been occasionally reported as a co-incidental event; however, reassessment of the presence of uterus should be done again after administration of exogenous estrogen replacement for at least 6-12 months. A multidisciplinary approach is necessary for patients presenting with DSD to ensure appropriate treatments and follow-up across the lifespan of individuals with DSD.
Collapse
|
15
|
Lenders NF, Greenfield JR. Urinary steroid profiling in diagnostic evaluation of an unusual adrenal mass. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190090. [PMID: 31778357 PMCID: PMC6893307 DOI: 10.1530/edm-19-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
SUMMARY Adrenal oncocytomas are rare tumours, with only approximately 160 cases reported in the literature. We report the use of urinary steroid profiling as part of their diagnostic evaluation and prognostication. A 45-year-old woman presented with clinical features of hyperandrogenism. Serum biochemistry confirmed androgen excess and computed tomography (CT) demonstrated a 3.2 cm adrenal tumour with density 39 HU pre-contrast. Urine steroid profiling showed elevated tetrahydro-11 deoxycortisol (THS), which is associated with adrenal malignancy. Laparoscopic adrenalectomy was performed, and histopathology diagnosed adrenal oncocytoma. Serum and urinary biochemistry resolved post-operatively and remained normal at 1-year follow-up. LEARNING POINTS Differential diagnosis of adrenal masses is challenging. Current techniques for differentiating between tumour types lack sensitivity and specificity. 24-h urinary steroid profiling is a useful tool for reflecting steroid output from adrenal glands. Gas chromatography-mass spectrometry (GC-MS) of urinary steroid metabolites has sensitivity and specificity of 90% for diagnosing adrenocortical carcinoma. Adrenal oncocytoma are rare tumours. Differentiating between benign and malignant types is difficult. Data guiding prognostication and management are sparse.
Collapse
Affiliation(s)
- N F Lenders
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J R Greenfield
- Diabetes and Metabolism, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- Department of Endocrinology, St Vincent’s Hospital, Sydney, New South Wales, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
16
|
Decaestecker K, Wijtvliet V, Coremans P, Van Doninck N. Olfactory neuroblastoma (esthesioneuroblastoma) presenting as ectopic ACTH syndrome: always follow your nose. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190093. [PMID: 31627184 DOI: 10.1530/edm-19-0093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/25/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY ACTH-dependent hypercortisolism is caused by an ectopic ACTH syndrome (EAS) in 20% of cases. We report a rare cause of EAS in a 41-year-old woman, presenting with clinical features of Cushing's syndrome which developed over several months. Biochemical tests revealed hypokalemic metabolic alkalosis and high morning cortisol and ACTH levels. Further testing, including 24-hour urine analysis, late-night saliva and low-dose dexamethasone suppression test, confirmed hypercortisolism. An MRI of the pituitary gland was normal. Inferior petrosal sinus sampling (IPSS) revealed inconsistent results, with a raised basal gradient but no rise after CRH stimulation. Additional PET-CT showed intense metabolic activity in the left nasal vault. Biopsy of this lesion revealed an unsuspected cause of Cushing's syndrome: an olfactory neuroblastoma (ONB) with positive immunostaining for ACTH. Our patient underwent transnasal resection of the tumour mass, followed by adjuvant radiotherapy. Normalisation of cortisol and ACTH levels was seen immediately after surgery. Hydrocortisone substitution was started to prevent withdrawal symptoms. As the hypothalamic-pituitary-axis slowly recovered, daily hydrocortisone doses were tapered and stopped 4 months after surgery. Clinical Cushing's stigmata improved gradually. LEARNING POINTS Ectopic ACTH syndrome can originate from tumours outside the thoracoabdominal region, like the sinonasal cavity. The diagnostic accuracy of IPSS is not 100%: both false positives and false negatives may occur and might be due to a sinonasal tumour with ectopic ACTH secretion. Olfactory neuroblastoma (syn. esthesioneuroblastoma), named because of its sensory (olfactory) and neuroectodermal origin in the upper nasal cavity, is a rare malignant neoplasm. It should not be confused with neuroblastoma, a tumour of the sympathetic nervous system typically occurring in children. If one criticises MRI of the pituitary gland because of ACTH-dependent hypercortisolism, one should take a close look at the sinonasal field as well.
Collapse
Affiliation(s)
- Karen Decaestecker
- Department of Diabetology-Endocrinology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Veerle Wijtvliet
- Department of Diabetology-Endocrinology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Peter Coremans
- Department of Diabetology-Endocrinology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Nike Van Doninck
- Department of Diabetology-Endocrinology, AZ Nikolaas, Sint-Niklaas, Belgium
| |
Collapse
|
17
|
Astaf'eva LI, Sidneva YG, Kadashev BA, Kalinin PL, Melnichenko GA, Agadzhanian SA. Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190023. [PMID: 31967975 DOI: 10.1530/edm-19-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6-7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. LEARNING POINTS Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.
Collapse
Affiliation(s)
- L I Astaf'eva
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - Y G Sidneva
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - B A Kadashev
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - P L Kalinin
- N.N. Burdenko National Medical Research Centre of NeurosurgeryMoscow, Russian Federation
| | - G A Melnichenko
- National Medical Research Centre of EndocrinologyMoscow, Russian Federation
| | - S A Agadzhanian
- Department of English Language for Natural FacultiesLomonosov Moscow State University, Moscow, Russian Federation
| |
Collapse
|
18
|
Eliason SK, Bockarie AS, Eliason C. Postpartum fertility behaviours and contraceptive use among women in rural Ghana. Contracept Reprod Med 2018; 3:13. [PMID: 30151239 PMCID: PMC6100709 DOI: 10.1186/s40834-018-0066-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/15/2018] [Indexed: 11/11/2022] Open
Abstract
Background Although most women would want to wait for more than two years before having another baby, their fertility behaviours during the first year following birth may decrease or increase the length of the birth interval. The objectives of this study were to: assess how protected postpartum women in the Mfantseman municipal were against pregnancy, based on their patterns of amenorrhoea and sexual abstinence; determine the timing of postpartum contraception in relation to amenorrhoea and sexual abstinence; and determine the predictors of postpartum contraceptive use. Methods This was a prospective study carried out in the Mfantseman Municipality of the Central region of Ghana. Out of 1914 women attending antenatal clinic in the municipal within the study period, 1350 agreed to be part of the study to ascertain their postpartum fertility and contraceptive behaviours a year following delivery. These women were traced to their communities using telephone and house numbers provided and only 1003 of the women were finally traced and interviewed. The women were asked about their breastfeeding behaviour, postpartum sexual abstinence, duration of amenorrhoea and postpartum contraceptive use. Results The mean age of the respondents was 29.9 ± 6.5 years; adolescents constituted the least proportion (3.3%) of the women. More than half (54.1%) of the women had Middle, Junior secondary school or Junior high school education. Most (43.3%) of the women were married by means of traditional rites and more than half (51.4%) of them were petty traders. The mean durations of breastfeeding, amenorrhoea and sexual abstinence were 6.6 ± 2.8 months, 7.8 ± 3.8 months and 4.4 ± 3.1 months respectively, whilst mean time of first contraceptive uptake was 3.5 ± 2.7 months postpartum. The time to first use of modern contraceptive method during the postpartum period indicates that about 50% of the women had started use of modern contraceptive methods by 2.7 months postpartum, and occured 0.6 and 3.6 months before sexual relations and resumption of menses respectively. Occupation (likelihood ratio p = 0.013), area of residence (likelihood ratio p = 0.004), mode of delivery (likelihood ratio p < 0.001), breastfeeding (p = 0.024), period since delivery (p < 0.001), preferred number of children (p < 0.001) and parity (p < 0.001) were found to be predictors of postpartum contraceptive use. Conclusion Postpartum women in the Mfantseman municipal who did not use contraceptives or delayed in the use of contraceptives after birth were least likely to be protected against pregnancy in the post partum period, whilst those who adopted postpartum family planning were likely to be better protected because they were likely to adopt it within the first three months after birth and before the onset of sexual relations and first menses. The predictors of postpartum contraceptive use were breastfeeding pattern, occupation, parity, preferred number of children, period since delivery, place of residence and mode of delivery.
Collapse
Affiliation(s)
- Sebastian Kofi Eliason
- 1Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ansumana Sandy Bockarie
- 1Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Cecilia Eliason
- 2FWACN School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| |
Collapse
|
19
|
Decanter C, Cloquet M, Dassonneville A, D'Orazio E, Mailliez A, Pigny P. Different patterns of ovarian recovery after cancer treatment suggest various individual ovarian susceptibilities to chemotherapy. Reprod Biomed Online 2018. [PMID: 29523398 DOI: 10.1016/j.rbmo.2018.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The relationship between early recovery of menstrual activity and blood anti-Müllerian hormone (AMH) concentrations were investigated within the first year post-chemotherapy in 32 young patients with breast cancer. All were treated by surgery and the same chemotherapy protocol (three cycles of FEC100 plus three cycles of taxanes). Menstrual activity, blood AMH (using picoAMH ELISA) and FSH concentrations were measured longitudinally before, during and up to 12 months after the end of chemotherapy (six samples per patient). Among the cohort, 17 patients recovered spontaneous cycles at +6 months (fast recovery) whereas the remaining 15 patients were still amenorrheic at that time (slow recovery). Blood AMH differed between these two subgroups at each time of the recovery phase starting at 3 months post-chemotherapy. The AMH patterns were also different: rapid and large increase in the fast recovery versus slow and partial increase in the slow recovery subgroup. No difference in ovarian recovery was observed between patients with a hormone positive or negative tumour. In conclusion, studying the post-chemotherapy patterns of menstrual activity and AMH, two paces of early ovarian recovery are distinguishable in young breast cancer patients who received the same chemotherapy protocol. This suggests different individual ovarian susceptibilities to chemotherapy.
Collapse
Affiliation(s)
- Christine Decanter
- Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, Lille F-59037 Cedex, France; EA 4308 Gamétogénèse et Qualité du Gamète, Centre Hospitalier Universitaire, Lille F-59037 Cedex, France
| | - Marc Cloquet
- Laboratoire de Biochimie and Hormonologie, Centre de Biologie Pathologie, CHRU, Lille F-59037 Cedex, France
| | - Audrey Dassonneville
- Laboratoire de Biochimie and Hormonologie, Centre de Biologie Pathologie, CHRU, Lille F-59037 Cedex, France
| | - Emmanuelle D'Orazio
- Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, Lille F-59037 Cedex, France
| | - Audrey Mailliez
- Département de Sénologie, Centre Régional de Lutte Contre le Cancer Oscar Lambret, Lille F-59037 Cedex, France
| | - Pascal Pigny
- Laboratoire de Biochimie and Hormonologie, Centre de Biologie Pathologie, CHRU, Lille F-59037 Cedex, France.
| |
Collapse
|
20
|
Vryonidou A, Paschou SA, Dimitropoulou F, Anagnostis P, Tzavara V, Katsivas A. Cardiac tamponade in a patient with autoimmune polyglandular syndrome type 2. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170097. [PMID: 29062486 PMCID: PMC5640567 DOI: 10.1530/edm-17-0097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022] Open
Abstract
We describe a case of a 40-year-old woman who was admitted to the intensive care unit with a rapid onset of dyspnea and orthopnea. She presented progressive weakness, weight loss and secondary amenorrhea during last year, while intermittent fever was present for the last two months. Initial biochemical evaluation showed anemia, hyponatremia and increased C-reactive protein levels. Clinical and echocardiographic evaluation revealed cardiac tamponade, which was treated with pericardiocentesis. Pleural fluid samples were negative for malignancy, tuberculosis or bacterial infection. Hormonal and serologic evaluation led to the diagnosis of autoimmune polyglandular syndrome (APS) type 2 (including primary adrenal insufficiency and autoimmune thyroiditis), possibly coexisting with systemic lupus erythematosus. After symptomatic rheumatologic treatment followed by replacement therapy with hydrocortisone and fludrocortisone, the patient fully recovered. In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered. Early diagnosis and non-invasive treatment can be life-saving. LEARNING POINTS In patients with the combination of polyserositis, cardiac tamponade and persistent hyponatremia, possible coexistence of rheumatologic and autoimmune endocrine disease, mainly adrenal insufficiency, should be considered.Early diagnosis and non-invasive treatment can be life-saving for these patients.Primary adrenal insufficiency requires lifelong replacement therapy with oral administration of 15-25 mg hydrocortisone in split doses and 50-200 µg fludrocortisone once daily.
Collapse
Affiliation(s)
- Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Fotini Dimitropoulou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Tzavara
- 3rd Department of Internal Medicine, Hellenic Red Cross Hospital, Athens, Greece
| | - Apostolos Katsivas
- 1st Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece
| |
Collapse
|
21
|
Frintrop L, Trinh S, Liesbrock J, Paulukat L, Kas MJ, Tolba R, Konrad K, Herpertz-Dahlmann B, Beyer C, Seitz J. Establishment of a chronic activity-based anorexia rat model. J Neurosci Methods 2018; 293:191-8. [PMID: 28970163 DOI: 10.1016/j.jneumeth.2017.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is often a chronic eating disorder characterised by body image disturbance and low body weight often associated with starvation-induced amenorrhoea and excessive exercise. Activity-based anorexia (ABA) is an animal model representing many somatic aspects of this psychiatric illness. We systematically manipulated the extent and length of starvation and animal age to find the optimal parameters to study chronic starvation. NEW METHODS Wistar rats had 24h/day running wheel access and received 40% of their baseline food intake until a 20% or 25% weight reduction was reached (acute starvation). This body weight was then maintained for two weeks (chronic starvation). The rats of different ages of 4 or 8 weeks were used to represent early and late adolescent animals, respectively. The complete absence of a menstrual cycle was defined as the primary outcome parameter. RESULTS Acute starvation caused a disruption of the oestrous cycle in 58% of the animals. During chronic starvation, a complete loss of the oestrous cycle could be found. Furthermore, 4-week-old rats exhibited higher levels of hyperactivity and amenorrhoea than 8-week-old animals. A 20% starvation level led to 90% loss of cycle, while a 25% starvation level triggered complete loss. COMPARISON WITH EXISTING METHODS Most current ABA models focus on acute starvation, while most patients are chronically ill. CONCLUSIONS The optimal parameters to achieve complete amenorrhoea included early adolescence, chronic starvation and 25% weight loss. The new ABA model allows studying the effects of chronic AN on underlying behavioural, hormonal and brain pathobiology.
Collapse
|
22
|
Bhavani G, Sivaprakash S, Samuel CR, Santhiya ST. Enhanced Expression of FRA16B using AT-Rich DNA Binding Chemicals in a Woman with Secondary Amenorrhoea. J Clin Diagn Res 2017; 11:QD01-QD03. [PMID: 28764253 DOI: 10.7860/jcdr/2017/26545.10043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022]
Abstract
Fragile sites represent regions of chromatin that fail to compact during mitosis. Based on the prevalence and pattern of inheritance they are classified as rare fragile sites or common fragile sites. Rare fragile sites either occur spontaneously or can be induced by certain AT-specific binding chemicals namely distamycin, Hoechst 33258, Berenil and others. The most common of all rare autosomal fragile sites is fra(16)(q22) with a heterozygote frequency of ~5%. FRA16B results from an expansion of a 33 bp AT-rich Minisatellite repeat. These rare forms are usually heritable and segregate in a Mendelian fashion. The proband who was referred for secondary amenorrhoea, revealed 46,XX,fra(16)(q22.1)pat karyotype. Her father and younger sibling were also found to be carriers. This study aimed to delineate the genotypic and phenotypic features exhibited by these carriers and to evaluate FRA16B expression using AT-specific binding chemicals. The additives employed were Berenil, BrdU and Hoechst 33258. Berenil at a concentration of 150 µg/ml showed the highest expression of FRA16B. Although the recent breakthrough in molecular characterization of fragile sites plays a critical role in comprehending their association with various diseases, the physiological link between them and amenorrhoea is not clearly understood.
Collapse
Affiliation(s)
- Gunasekaran Bhavani
- Ph.D. Research Scholar, Department of of Genetics, Dr. ALM Postgraduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
| | - S Sivaprakash
- Assistant Professor, Department of Endocrinology and Diabetology, Institute of Obstetrics and Gynaecology, Government Hospital for Women and Children, Egmore, Chennai, Tamil Nadu, India
| | - Chandra R Samuel
- Associate Professor, Department of of Genetics, Dr. ALM Postgraduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
| | - Sathiyavedu Thyagarajan Santhiya
- Professor and Head (Retd.), Department of of Genetics, Dr. ALM Postgraduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai, Tamil Nadu, India
| |
Collapse
|
23
|
Tahmina S, Daniel M, Solomon P. Clinical Analysis of Ectopic Pregnancies in a Tertiary Care Centre in Southern India: A Six-Year Retrospective Study. J Clin Diagn Res 2016; 10:QC13-QC16. [PMID: 27891402 DOI: 10.7860/jcdr/2016/21925.8718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Ectopic Pregnancy (EP) is a life-threatening emergency commonly encountered by medical practitioners where diagnosis can often be missed. Any woman in the reproductive age group, presenting with lower abdominal pain or vaginal bleeding must raise the suspicion of an ectopic pregnancy to prevent mortality and morbidity. AIM To review all cases of EP and determine the incidence of EP. To study the high risk factors and know the types of clinical presentation, methods of diagnosis, outcome and complications. MATERIALS AND METHODS This was a retrospective cohort study, conducted at a tertiary care medical teaching hospital in Pondicherry, India. Medical records of all women with an EP between 2009 and 2015 were retrieved. Demographic data, parity, risk factors, clinical features, mode of management and need for blood transfusion was noted. Main outcome measures studied were the incidence of EP, risk factors, mortality and morbidity in these women. STATISTICAL ANALYSIS Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software version 19.0. For categorical variables, data was compiled as frequency and percent. For continuous variables, data was calculated as mean ± SD. RESULTS Seventy-two EP were diagnosed during the six-year period with an incidence of 9.1/1000 pregnancies. Majority of women were aged 21-30years (51.39%), 27.8% women were nulliparous. The most common risk factors were previous abortion (36.1%) and pelvic surgery (37.50%). Fifteen cases (20.8%) were diagnosed in women who had tubectomy. The classic triad of lower abdominal pain, amenorrhoea and vaginal bleeding was seen in 29(40.3%) cases. Ultrasonography was required to arrive at a diagnosis in 28(38.9%) cases. Urine pregnancy test was positive in 100% of cases. Majority (94.4%) were tubal ectopic pregnancies. Medical management with methotrexate alone benefitted 10(13.89%) of patients while another four required surgery for failed medical management. More than half of the patients (59.7%) required blood transfusion and two (2.8%) had transfusion related acute lung injury. No deaths were noted. CONCLUSION Common risk factors for EP must be identified. Use of transvaginal ultrasonography and human chorionic gonadotropin assay have revolutionised the management of EP and serve as valuable adjuncts to early diagnosis and management.
Collapse
Affiliation(s)
- S Tahmina
- Assistant Professor, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Mary Daniel
- Professor and Head, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India
| | - Preethy Solomon
- Junior Resident, Department of Obstetrics & Gynaecology, Pondicherry Institute of Medical Sciences , Pondicherry, India
| |
Collapse
|
24
|
Li XS, Lv Q, Du ZG, Chen J. Prediction of ovarian function in premenopausal breast cancer patients with amenorrhoea after chemotherapy: a simple clinical score. Springerplus 2016; 5:1052. [PMID: 27462500 PMCID: PMC4940309 DOI: 10.1186/s40064-016-2671-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/25/2016] [Indexed: 02/05/2023]
Abstract
We evaluated a non-invasive method for predicting the ovarian function of premenopausal breast cancer patients with amenorrhoea after chemotherapy. A total of 34 patients had ovarian function, whereas 56 had no ovarian function. Logistic regression analysis indicated that age (P = 0.034; hazards ratio [HR], 0.29; confidence interval [CI], 0.091–0.910), follicle-stimulating hormone (P = 0.032; HR 0.97; CI 0.944–0.997) and oestradiol (P = 0.047; HR 1.01; CI 1.000–1.015) were independent influencing factors that determine ovarian function. The ovarian function score (OFS) (P < 0.001; HR 48.00; CI 10.174–226.452) was obtained through a comprehensive analysis of these three variables, and it could more effectively predict ovarian function. According to receiver operating characteristic curve analysis, the OFS had the highest values compared with the other three variables (sensitivity, 94.6 %; specificity, 79.3 %). The OFS is simple and easy to use; thus, it is expected to become a new method for determining drug-induced amenorrhoea in women with breast cancer. Ovarian function likely still exists if the OFS is ≤1.
Collapse
Affiliation(s)
- Xiao Shi Li
- Department of Thyroid and Breast Surgery, West China Hospital of Sichuan University, Guo xue Lane 37, Chengdu, China
| | - Qing Lv
- Department of Thyroid and Breast Surgery, West China Hospital of Sichuan University, Guo xue Lane 37, Chengdu, China
| | - Zheng Gui Du
- Department of Thyroid and Breast Surgery, West China Hospital of Sichuan University, Guo xue Lane 37, Chengdu, China
| | - Jie Chen
- Department of Thyroid and Breast Surgery, West China Hospital of Sichuan University, Guo xue Lane 37, Chengdu, China
| |
Collapse
|
25
|
Bakker ICA, Schubart CD, Zelissen PMJ. Successful treatment of a prolactinoma with the antipsychotic drug aripiprazole. Endocrinol Diabetes Metab Case Rep 2016; 2016:160028. [PMID: 27284453 PMCID: PMC4898067 DOI: 10.1530/edm-16-0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 05/13/2016] [Indexed: 01/22/2023] Open
Abstract
In this report, we describe a female patient with both prolactinoma and psychotic disorder who was successfully treated with aripiprazole, a partial dopamine 2 receptor agonist. During the follow-up of more than 10 years, her psychotic symptoms improved considerably, prolactin levels normalised and the size of the prolactinoma decreased. This observation may be of clinical relevance in similar patients who often are difficult to treat with the regular dopaminergic drugs.
Collapse
Affiliation(s)
- Ilse C A Bakker
- Department of Internal Medicine, Section of Endocrinology , University Medical Center Utrecht, Utrecht , The Netherlands
| | - Chris D Schubart
- Department of Psychiatry , Tergooi Hospital, Hilversum , The Netherlands
| | - Pierre M J Zelissen
- Department of Internal Medicine, Section of Endocrinology , University Medical Center Utrecht, Utrecht , The Netherlands
| |
Collapse
|
26
|
Rathod S, Samal SK. Secondary vaginal atresia treated with vaginoplasty using amnion graft: a case report. J Clin Diagn Res 2015; 8:OD05-6. [PMID: 25584275 DOI: 10.7860/jcdr/2014/10674.5207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/08/2014] [Indexed: 11/24/2022]
Abstract
We report a case of 26-year-old primipara with last child birth 1.5 year back who presented with amenorrhoea, cyclical lower abdominal pain and dyspareunia for past six months. Examination revealed vaginal atresia secondary to previous traumatic/mismanaged vaginal delivery with haematocolpos. She was managed by vaginoplasty with amnion graft and regular dilation with soft vaginal mould for six weeks and was advised for regular intercourse after that. On follow up our patient was doing well with restoration of normal coital function.
Collapse
Affiliation(s)
- Setu Rathod
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College & Research Institute , Puducherry, India
| | - Sunil Kumar Samal
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College & Research Institute , Puducherry, India
| |
Collapse
|
27
|
Ayed W, Amouri A, Hammami W, Kilani O, Turki Z, Harzallah F, Bouayed-Abdelmoula N, Chemkhi I, Zhioua F, Slama CB. Cytogenetic abnormalities in Tunisian women with premature ovarian failure. C R Biol 2014; 337:691-4. [PMID: 25433561 DOI: 10.1016/j.crvi.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
To identify the distribution of chromosome abnormalities among Tunisian women with premature ovarian failure (POF) referred to the department of Cytogenetic at the Pasteur Institute of Tunis (Tunisia), standard cytogenetic analysis was carried out in a total of 100 women younger than 40 affected with premature ovarian failure. We identified 18 chromosomal abnormalities, including seven X-numerical anomalies in mosaic and non-mosaic state (45,X; 47,XXX), four sex reversal, three X-structural abnormalities (terminal deletion and isochromosomes), one autosomal translocation and one supernumerary marker. The overall prevalence of chromosomal abnormalities was 18% in our cohort. X chromosome aneuploidy was the most frequent aberration. This finding confirms the essential role of X chromosome in ovarian function and underlies the importance of cytogenetic investigations in the routine management of POF.
Collapse
Affiliation(s)
- Wiem Ayed
- Laboratory of Histology and Cytogenetics, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisia; Faculté de médecine de Tunis, Université El-Manar, 15, rue Djebel-Lakhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Ahlem Amouri
- Laboratory of Histology and Cytogenetics, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisia; Faculté de médecine de Tunis, Université El-Manar, 15, rue Djebel-Lakhdhar, La Rabta, 1007 Tunis, Tunisia.
| | - Wajih Hammami
- Laboratory of Histology and Cytogenetics, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisia; Faculté de médecine de Tunis, Université El-Manar, 15, rue Djebel-Lakhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Olfa Kilani
- Laboratory of Histology and Cytogenetics, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisia; Faculté de médecine de Tunis, Université El-Manar, 15, rue Djebel-Lakhdhar, La Rabta, 1007 Tunis, Tunisia
| | - Zinet Turki
- Endocrinology Department, La Rabta Hospital and Al Manar University Tunis, rue Djebel-Lakhdhar, 1007 Tunis, Tunisia
| | - Fatma Harzallah
- Hôpital régional Mahmoud El Matri, rue Ibnou-Khaldoun, Ariana, Tunisia
| | - Nouha Bouayed-Abdelmoula
- Département d'histologie embryologie, faculté de médicine de Sfax, boulevard Majida-Boulila, 3029 Sfax, Tunisia
| | - Imen Chemkhi
- Laboratory of Histology and Cytogenetics, Institut Pasteur de Tunis, 13, place Pasteur, BP 74, 1002 Tunis, Tunisia
| | - Fethi Zhioua
- Department of Obstetrics and Gynecology, Aziza Othmana University Hospital, place du Gouvernement, La Kasba, 1008 Tunis, Tunisia
| | - Claude Ben Slama
- Endocrinology Department, La Rabta Hospital and Al Manar University Tunis, rue Djebel-Lakhdhar, 1007 Tunis, Tunisia
| |
Collapse
|
28
|
Abstract
Growth failure and pubertal abnormalities are not uncommon in chronic uncontrolled metabolic diseases like diabetes mellitus. We present a young girl with uncontrolled type 1 diabetes mellitus, who presented with short stature and primary amenorrhea, and on evaluation was found to have anterior pituitary hypoplasia. In addition to uncontrolled diabetes mellitus, she presented with early onset growth failure and lack of spontaneous secondary sexual characteristics. She had central hypothyroidism and inappropriately normal gonadotropin levels. However her serum cortisol levels were normal. MRI of the sellar-suprasellar region revealed a small anterior pituitary gland with thinning of the pituitary stalk consistent with pituitary hypoplasia. While uncontrolled type 1 diabetes itself may cause growth retardation and pubertal abnormalities, this girl had coexisting pituitary maldevelopment - a rare co-existence of two major illnesses of unrelated etiologies. The partial pituitary hormonal deficiency, which spared the hypothalamo-pituitary-adrenal axis, may be due to a transcription factor defect.
Collapse
Affiliation(s)
- Jostol Pinto
- Department of General Medicine, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India.
| | - K Sudeep
- Head of Endocrinology Unit, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India
| | - B M Venkatesha
- Department of General Medicine, Father Muller Medical College, Rajiv Gandhi University of Health Sciences, India
| |
Collapse
|
29
|
Xiao C, Zhao J, Li M, Zhao D, Xiang Y. Lupus nephritis associated with placental site trophoblastic tumor: A case report and review of the literature. Gynecol Oncol Case Rep 2014; 9:26-8. [PMID: 24944882 PMCID: PMC4060261 DOI: 10.1016/j.gynor.2014.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/20/2014] [Indexed: 11/26/2022]
Abstract
The present case is the first case report of PSTT associated with lupus nephritis. The patient presented with lupus nephritis as paraneoplastic nephropathy before PSTT discovered, and rapidly achieved complete remission after hysterectomy. This unusual findings must be interpreted appropriately to achieve the correct diagnosis.
Collapse
Affiliation(s)
- Changji Xiao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mengtao Li
- Department of Rheumatology & Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
30
|
Chirico V, Ferraù V, Loddo I, Briuglia S, Amorini M, Salpietro V, Lacquaniti A, Salpietro C, Arrigo T. LMNA gene mutation as a model of cardiometabolic dysfunction: from genetic analysis to treatment response. Diabetes Metab 2014; 40:224-8. [PMID: 24485160 DOI: 10.1016/j.diabet.2013.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 11/23/2022]
Abstract
AIM This report highlights the metabolic, endocrine and cardiovascular comorbidities in a case of familial partial lipodystrophy (FPLD), and also evaluates the efficacy and safety of metformin therapy. METHODS Mutational analysis was carried out of the LMNA gene in a teenage girl with an FPLD phenotype. Insulin resistance, sex hormones and metabolic parameters were also evaluated, and echocardiography, electrocardiography and 24-h blood pressure monitoring were also done. RESULTS The patient showed atypical fat distribution, insulin resistance and hypertrophic cardiomyopathy. Physical examination revealed muscle hypertrophy with a paucity of fat in the extremities, trunk and gluteal regions, yet excess fat deposits in the face, neck and dorsal cervical region. LMNA sequencing revealed a heterozygous missense mutation (c.1543A>G) in exon 9, leading to substitution of lysine by glutamic acid at position 515 (K515E). Moderate hypertension and secondary polycystic ovary syndrome were also assessed. Treatment with metformin resulted in progressive improvement of metabolic status, while blood pressure values normalized with atenolol therapy. CONCLUSIONS Very rapid and good results with no side-effects were achieved with metformin therapy for FPLD. The association of an unusual mutation in the LMNA gene was also described.
Collapse
|
31
|
Anderson RA, Rosendahl M, Kelsey TW, Cameron DA. Pretreatment anti-Müllerian hormone predicts for loss of ovarian function after chemotherapy for early breast cancer. Eur J Cancer 2013; 49:3404-11. [PMID: 23968732 PMCID: PMC3807650 DOI: 10.1016/j.ejca.2013.07.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 10/28/2022]
Abstract
AIM Improving survival for women with early breast cancer (eBC) requires greater attention to the consequences of treatment, including risk to ovarian function. We have assessed whether biochemical markers of the ovarian reserve might improve prediction of chemotherapy related amenorrhoea. METHODS Women (n=59, mean age 42.6 years [(range 23.3-52.5]) with eBC were recruited before any treatment. Pretreatment ovarian reserve markers (anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], inhibin B) were analysed in relation to ovarian status at 2 years. RESULTS Pretreatment AMH was significantly lower in women with amenorrhoea at 2 years (4.0 ± 0.9 pmol/L versus 17.2 ± 2.5, P<0.0001), but FSH and inhibin B did not differ between groups. By logistic regression, pretreatment AMH, but not age, FSH or inhibin B, was an independent predictor of ovarian status at 2 years (P=0.005; odds ratio 0.013). We combined these data with a similar cohort (combined n=75); receiver-operator characteristic analysis for AMH gave area under curve (AUC) of 0.90 (95% confidence interval (CI) 0.82-0.97)). A cross-validated classification tree analysis resulted in a binary classification schema with sensitivity 98.2% and specificity 80.0% for correct classification of amenorrhoea. CONCLUSION Pretreatment AMH is a useful predictor of long term post chemotherapy loss of ovarian function in women with eBC, adding significantly to the only previously established individualising predictor, i.e. age. AMH measurement may assist decision-making regarding treatment options and fertility preservation procedures.
Collapse
Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
| | | | | | | |
Collapse
|
32
|
Abstract
The liver and its pleotropic functions play a fundamental role in regulating metabolism, and is also an inevitable target of multiple metabolic disorders. The numerous and constant relationships and feedback mechanisms between the liver and all endocrine organs is reflected by the fact that an alteration of one oftentimes results in the malfunction of the other. Hypo- and hyperthyroidism are frequently associated with hepatic alterations, and thyroid diseases must be excluded in transaminase elevation of unknown cause. Drugs such as propylthiouracil, used in the treatment of hyperthyroidism, may induce liver damage, and other drugs such as amiodarone, carbamazepine, and several chemotherapeutic agents can lead to both thyroid and liver abnormalities. Liver diseases such as hepatitis, hepatocellular carcinoma, and cirrhosis may cause altered levels of thyroid hormones, and alcoholic liver disease, both due to the noxious substance ethanol as well as to the hepatic damage it causes, may be responsible for altered thyroid function. Both excess and insufficiency of adrenal function may result in altered liver function, and adrenocortical dysfunction may be present in patients with cirrhosis, especially during episodes of decompensation. Again an important player which affects both the endocrine system and the liver, alcohol may be associated with pseudo-Cushing syndrome. Sex hormones, both intrinsic as well as extrinsically administered, have an important impact on liver function. While oestrogens are related to cholestatic liver damage, androgens are the culprit of adenomas and hepatocellular carcinoma, among others. Chronic liver disease, on the other hand, has profound repercussions on sex hormone metabolism, inducing feminization in men and infertility and amenorrhoea in women. Lastly, metabolic syndrome, the pandemia of the present and future centuries, links the spectrum of liver damage ranging from steatosis to cirrhosis, to the array of endocrine alterations that are features of the syndrome, including insulin resistance, central obesity, and hyperlipidaemia. Clinical practice must integrally evaluate the effects of the intricate and tight relationship between the liver and the endocrine system, in order to better address all manifestations, complications, and prevent deterioration of one or the other organ-system.
Collapse
|
33
|
Guin G, Sandhu SK, Lele A, Khare S. Hysteroscopy in evaluation of abnormal uterine bleeding. J Obstet Gynaecol India 2011; 61:546-9. [PMID: 23024527 PMCID: PMC3257342 DOI: 10.1007/s13224-011-0088-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 08/04/2011] [Indexed: 10/15/2022] Open
Abstract
UNLABELLED One-third of all gynaecological consultations are because of abnormal uterine bleeding (AUB). This proportion rises to more than 2/3rd when peri & post menopausal women are considered. In normal to 12 week size uteri, the cause of abnormal bleeding often remains obscure. OBJECTIVES (S): Clinical and hysteroscopic evaluation of the cervical canal & uterine cavity of 100 women with AUB to evaluate various causes of AUB in the study population. METHOD (S): 100 women with AUB and uterine size normal to 12 weeks pregnancy were subjected to clinical & hysteroscopic examination. The cause of bleeding was evaluated. RESULTS Menorrhagia (30%), menometrorrhagia (16%), oligomenorrhea (16%) and postmenopausal bleeding (2%) were some of the indications for hysteroscopy. Intrauterine pathology was diagnosed in 74% of cases. Hyperplastic endometrium (30%) and mucus polypi (28%) were the most frequent findings. 13% of the cases had multiple finding. A surprising 7% had IUCD in their uteri without their knowledge, while bony spicules was found in 1 patient. Both patients with post menopausal bleeding had atrophic endometrium. CONCLUSION (S): Hysteroscopy can be easily learnt. It gives a clue to diagnosis in AUB and can reduce the burden of hysterectomy in many cases which can be treated by simple procedures.
Collapse
Affiliation(s)
- Gita Guin
- Department of Obstetrics and Gynaecology, Government N.S.C.B. Medical College, 436, Kamla Nehru Nagar, Garha Road, Jabalpur, MP 482 002 India
| | - Surpreet Kaur Sandhu
- Department of Obstetrics and Gynaecology, Government N.S.C.B. Medical College, 436, Kamla Nehru Nagar, Garha Road, Jabalpur, MP 482 002 India
| | - Arvind Lele
- Department of Obstetrics and Gynaecology, Government N.S.C.B. Medical College, 436, Kamla Nehru Nagar, Garha Road, Jabalpur, MP 482 002 India
| | - Shashi Khare
- Department of Obstetrics and Gynaecology, Government N.S.C.B. Medical College, 436, Kamla Nehru Nagar, Garha Road, Jabalpur, MP 482 002 India
| |
Collapse
|