1
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Valiño G, Dunlap K, Quintana L. Androgen receptors rapidly modulate non-breeding aggression in male and female weakly electric fish (Gymnotus omarorum). Horm Behav 2024; 159:105475. [PMID: 38154435 DOI: 10.1016/j.yhbeh.2023.105475] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
The South American weakly electric fish, Gymnotus omarorum, displays territorial aggression year-round in both sexes. To examine the role of rapid androgen modulation in non-breeding aggression, we administered acetate cyproterone (CPA), a potent inhibitor of androgen receptors, to both male and females, just before staged agonistic interactions. Wild-caught fish were injected with CPA and, 30 min later, paired in intrasexual dyads. We then recorded the agonistic behavior which encompasses both locomotor displays and emission of social electric signals. We found that CPA had no discernible impact on the levels of aggression or the motivation to engage in aggressive behavior for either sex. However, CPA specifically decreased the expression of social electric signals in both males and female dyads. The effect was status-dependent as it only affected subordinate electrocommunication behavior, the emission of brief interruptions in their electric signaling ("offs"). This study is the first demonstration of a direct and rapid androgen effect mediated via androgen receptors on non-breeding aggression. Elucidating the mechanisms involved in non-breeding aggression in this teleost model allows us to better understand potentially conserved or convergent neuroendocrine mechanisms underlying aggression in vertebrates.
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Affiliation(s)
- Guillermo Valiño
- Departamento de Neurofisiología Celular y Molecular, Instituto de Investigaciones Biológicas Clemente Estable, MEC, Montevideo, Uruguay
| | - Kent Dunlap
- Department of Biology, Trinity College, Hartford, CT, United States
| | - Laura Quintana
- Departamento de Neurofisiología Celular y Molecular, Instituto de Investigaciones Biológicas Clemente Estable, MEC, Montevideo, Uruguay.
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2
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Tammaro A, Lori G, Martinelli A, Cancemi L, Tassinari R, Maranghi F. Risk assessment of transgender people: implementation of a demasculinizing-feminizing rodent model including the evaluation of thyroid homeostasis. Biol Direct 2024; 19:5. [PMID: 38166984 PMCID: PMC10759629 DOI: 10.1186/s13062-023-00450-1] [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: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Individuals whose gender identity differs from the biological sex and the social norms are defined as transgender. Sometimes transgender undergo gender affirming hormone therapy, which lasts for the entire life making essential to evaluate its potential long-term effects. Moreover, transgender can represent a susceptible sub-group of population and specific attention is needed in risk assessment, including the development of targeted animal models. Aim of the study is the implementation of a rodent demasculinizing-feminizing model through the setting of appropriate dose of hormone therapy and the selection of specific biomarkers to evaluate the sex transition. Specific attention is paid to thyroid homeostasis due to the close link with reproductive functions. Four male adult rats/group were subcutaneously exposed to three doses plus control of β-estradiol valerate plus cyproterone acetate at: 0.045 + 0.2 (low), 0.09 + 0.2 (medium) and 0.18 + 0.2 (high) mg/dose, five times/week. The doses were selected considering the most recent recommendations for transgender woman. Sperm count, histopathological analysis (testis, liver, thyroid), testosterone, estradiol, triiodothyronine and thyroid-stimulating hormone serum levels and gene expression of sex dimorphic CYP450 were evaluated. RESULTS The doses induced feminizing-demasculinizing effects: decreased testosterone serum levels at the corresponding cisgender, increased estradiol, impairment of male reproductive function and reversal of sex-specific CYP liver expression. However, the medium and high doses induced marked liver toxicity and the low dose is considered the best choice, also for long-term studies in risk assessment. The alterations of thyroid indicated follicular cell hypertrophy supported by increased thyroid-stimulating hormone serum levels at the higher doses. CONCLUSIONS The implementation of animal models that mimic the effects of gender affirming hormone therapy is essential for supporting clinical studies in transgender people and filling data gap in order to ensure an appropriate risk assessment and a more accurate, personalized care for transgender people.
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Affiliation(s)
- Alessia Tammaro
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Gabriele Lori
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Martinelli
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, Rome, Italy
| | - Luigia Cancemi
- Experimental Animal Welfare Sector, Istituto Superiore di Sanità, Rome, Italy
| | - Roberta Tassinari
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy.
| | - Francesca Maranghi
- Center for Gender-Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
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3
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Gutmann M, Stimpfl E, Langmann G, Koudelka H, Mir-Karner B, Grasl-Kraupp B. Differentiated and non-differentiated HepaRG™ cells: A possible in-vitro model system for early hepatocarcinogenesis and non-genotoxic carcinogens. Toxicol Lett 2023; 390:15-24. [PMID: 37890683 DOI: 10.1016/j.toxlet.2023.10.014] [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: 06/21/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
Many xenobiotics are non-genotoxic carcinogens (NGC) in rodent liver. Their mode of action (MoA) and health risks for humans are unclear and no in-vitro tests are available to predict NGC. Human HepaRG™ cells in the differentiated (d-HepaRG) and non-differentiated state (nd-HepaRG) were studied as new approach methodology (NAM) for NGC. Cell-biological assays were performed with d-/nd-HepaRG and human hepatoma/hepatocarcinoma cell lines to characterize the benign/malignant phenotype. Reaction of d-/nd-HepaRG to several liver growth factors and NGC (phenobarbital, PB; cyproterone acetate, CPA; WY-14643) was compared to unaltered and premalignant rat hepatocytes in ex-vivo culture. Enzyme induction by NGC was checked by RT-qPCR/oligo-arrays. Growth, anchorage-independency, migration, clonogenicity, and in-vivo tumorigenicity of nd-HepaRG ranged between benign d-HepaRG and malignant hepatoma/hepatocarcinoma cells. All growth factors elevated DNA replication of d-/nd-HepaRG cells, similarly to unaltered/premalignant rat hepatocytes. NGC induced their prototypical enzymes in the rat and human cells, but elicited a growth response only in the unaltered/premalignant rat hepatocytes and not in human d-/nd-HepaRG cells. To conclude, a benign/premalignant phenotype of d-/nd-HepaRG cells and a reactivity towards several hepatic growth factors and NGC, as known from human hepatocytes, are essential components for an in-vitro model for early stage human hepatocarcinogenesis.The potential value as new approach methodology (NAM) for NGC is discussed.
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Affiliation(s)
- Michael Gutmann
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria
| | - Emily Stimpfl
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria
| | - Gregor Langmann
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria
| | - Helga Koudelka
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria
| | - Birgit Mir-Karner
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria
| | - Bettina Grasl-Kraupp
- Center for Cancer Research, Medical University of Vienna, Borschkegasse 8a, 1090 Vienna, Austria.
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4
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Ghosh C, Maity R, Roy A, Mallick C. Dose-Dependent Protective Effect of Hygrophila auriculata Seeds on Cyproterone Acetate-Induced Testicular Dysfunction. Reprod Sci 2023; 30:3359-3371. [PMID: 37286756 DOI: 10.1007/s43032-023-01279-9] [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: 11/19/2022] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
Infertility affects 15% of global population. This study was designed to search out the most effective dose of chloroform fraction of hydro-ethanolic extract of Hygrophila auriculata seed to ameliorate cyproterone acetate (CPA)-treated male subfertility. The rats were made subfertile by CPA at the dose of 2.5 mg/100gm body weight for 45 days. The male subfertility represented by low sperm concentration, less motile, less viable, and less hypo osmotic tail swelled spermatozoa in CPA-treated group. Serum LH, FSH, and testosterone levels were significantly decreased in CPA-treated group in respect to control. Androgenic key enzyme Δ5,3β-HSD, 17β-HSD activities and gene expression pattern were also decreased significantly in respect to control. These antispermatogenic and antiandrogenic activities of CPA were significantly recovered after the treatment of Hygrophila auriculata at the dose of 2.5 mg, 5mg, and 10 mg/100gm body weight. CPA also generate oxidative free radical that indicated by altered catalase, superoxide dismutase, and peroxidase activities and protein expression pattern along with conjugated diene and thiobarbituric acid reactive substance levels in testis. Expression pattern of Bax and Bcl2 genes were deviated from control after CPA treatment. Significant diminution of body weight, organo-somatic indices, and SGOT, SGPT activities were observed in CPA-treated group. All these biomarkers significantly recovered towards control after the treatment of Hygrophila auriculata at different doses. More significant recovery was observed in 5 mg and 10 mg of chloroform fraction-treated group and 5 mg dose, i.e., the minimum therapeutic dose to recover the CPA-induced subfertility.
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Affiliation(s)
- Chaitali Ghosh
- Clinical Nutrition and Dietetics, Department of Biomedical Laboratory Science and Management (UGC Innovative Department), Vidyasagar University, Midnapore, West Bengal, 721 102, India
| | - Ratnabali Maity
- Clinical Nutrition and Dietetics, Department of Biomedical Laboratory Science and Management (UGC Innovative Department), Vidyasagar University, Midnapore, West Bengal, 721 102, India
| | - Aaishi Roy
- Clinical Nutrition and Dietetics, Department of Biomedical Laboratory Science and Management (UGC Innovative Department), Vidyasagar University, Midnapore, West Bengal, 721 102, India
| | - Chhanda Mallick
- Clinical Nutrition and Dietetics, Department of Biomedical Laboratory Science and Management (UGC Innovative Department), Vidyasagar University, Midnapore, West Bengal, 721 102, India.
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5
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Cornu E, Pintiaux A, Reuter G, Kridelka F, Pétrossians P, Potorac I. [Meningioma under progestin treatment : what attitude to adopt ?]. Rev Med Liege 2023; 78:550-557. [PMID: 37830319] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The risks of meningioma associated with the use of cyproterone acetate at high doses (25 to 100 mg/day) have been known since 2007. Recently, two additional molecules have been incriminated: nomegestrol acetate and chlormadinone acetate. The higher the cumulative dose and the longer the treatment duration, the bigger the risk of meningioma (12-fold after 5 years of treatment for nomegestrol acetate, and 7-fold after 3.5 years of treatment for chlormadinone acetate). Nevertheless, these medications have many indications that demonstrate their importance in the daily practice of the general practitioner, of the gynecologist and of the reproductive endocrinologist. Therefore, caution is required when introducing a powerful progestin that is incriminated in the long term at high doses. If the benefit/risk balance favours the initiation of progestin therapy, it is recommended to use the minimal effective dose and to limit the duration of use. Clinical and brain imaging monitoring should also be performed. Finally, if a meningioma develops on progestin, it is recommended that any medication containing a progesterone agonist be suspended.
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Affiliation(s)
- Emma Cornu
- Service de Gynécologie, CHU Liège, Belgique
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6
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Kheloui S, Smith A, Ismail N. Combined oral contraceptives and mental health: Are adolescence and the gut-brain axis the missing links? Front Neuroendocrinol 2023; 68:101041. [PMID: 36244525 DOI: 10.1016/j.yfrne.2022.101041] [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: 07/22/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
Combined oral contraceptives (containing synthetic forms of estradiol and progestins) are one of the most commonly used drugs among females. However, their effects on the gut-brain axis have not been investigated to a great extent despite clear evidence that suggest bi-directional interactions between the gut microbiome and endogenous sex hormones. Moreover, oral contraceptives are prescribed during adolescence, a critical period of development during which several brain structures and systems, such as hypothalamic-pituitary-gonadal axis, undergo maturation. Considering that oral contraceptives could impact the developing adolescent brain and that these effects may be mediated by the gut-brain axis, further research investigating the effects of oral contraceptives on the gut-brain axis is imperative. This article briefly reviews evidence from animal and human studies on the effects of combined oral contraceptives on the brain and the gut microbiota particularly during adolescence.
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Affiliation(s)
- Sarah Kheloui
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Nafissa Ismail
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada; uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada; LIFE Research Institute, Ottawa, ON, Canada.
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7
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Martinez-Martin FJ, Kuzior A, Hernandez-Lazaro A, de Leon-Durango RJ, Rios-Gomez C, Santana-Ojeda B, Perez-Rivero JM, Fernandez-Trujillo-Comenge PM, Gonzalez-Diaz P, Arnas-Leon C, Acosta-Calero C, Perdomo-Herrera E, Tocino-Hernandez AL, Del Sol Sanchez-Bacaicoa M, Del Pino Perez-Garcia M. Incidence of hypertension in young transgender people after a 5-year follow-up: association with gender-affirming hormonal therapy. Hypertens Res 2023; 46:219-225. [PMID: 36229533 DOI: 10.1038/s41440-022-01067-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/14/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 02/03/2023]
Abstract
In order to assess the risk of hypertension development, we performed a retrospective analysis of the clinical records of consecutive transgender patients who began gender-affirming hormonal therapy in our Outpatient Gender Identity Clinic with <30 years of age and had a follow-up >5 years. 149 transgender women treated with estradiol and 153 transgender men treated with testosterone were included; 129 of the transgender women received also androgen blockers (54 spironolactone, 49 cyproterone acetate and 26 LHRH agonists). The annual incidence of hypertension in young transgender men (1.18%) seemed comparable to that of the general population. In young transgender women, it seemed higher (2.14%); we found that the choice of androgen blocker had a remarkable effect, with a highly significant increase in patients treated with cyproterone acetate (4.90%) vs. the rest (0.80%); the adjusted hazard-ratio was 0.227 (p = 0.001). Correlation, logistic regression and mediation analyses were performed for the associations of the available clinical variables with the increase in systolic blood pressure and the onset of hypertension, but besides the use of cyproterone acetate, only the ponderal gain was found significant (Spearman's r: 0.361, p < 0.001); with a 36.7% mediation effect (31.2-42.3%). Cyproterone acetate has additional known risks, such as meningioma; although we cannot conclusively prove that it has a role in the development of hypertension, we conclude that the use of cyproterone acetate for this indication should be reconsidered.
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Affiliation(s)
- Francisco Javier Martinez-Martin
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain. .,Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain.
| | - Agnieszka Kuzior
- Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Alba Hernandez-Lazaro
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Ricardo Jose de Leon-Durango
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Carlos Rios-Gomez
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Borja Santana-Ojeda
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | | | - Paula Maria Fernandez-Trujillo-Comenge
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Paula Gonzalez-Diaz
- Emergency Medicine Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Claudia Arnas-Leon
- Outpatient Gender Identity Clinic, Endocrinology & Nutrition Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain.,Endocrinology & Nutrition Dpt., Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Carmen Acosta-Calero
- Cardiology Dpt., Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Canary Islands, Spain
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8
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Samoyeau T, Provost C, Roux A, Legrand L, Dezamis E, Plu-Bureau G, Pallud J, Oppenheim C, Benzakoun J. Meningioma in patients exposed to progestin drugs: results from a real-life screening program. J Neurooncol 2022; 160:127-136. [PMID: 36066786 DOI: 10.1007/s11060-022-04124-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/04/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the results of systematic meningioma screening program implemented by French authorities in patients exposed to progestin therapies (cyproterone (CPA), nomegestrol (NA), and chlormadinone (CMA) acetate). METHODS We conducted a prospective monocentric study on patients who, between September 2018 and April 2021, underwent standardized MRI (injection of gadolinium, then a T2 axial FLAIR and a 3D-T1 gradient-echo sequence) for meningioma screening. RESULTS Of the 210 included patients, 15 (7.1%) had at least one meningioma; seven (7/15, 47%) had multiple meningiomas. Meningiomas were more frequent in older patients and after exposure to CPA (13/103, 13%) compared to NA (1/22, 4%) or CMA (1/85, 1%; P = 0.005). After CPA exposure, meningiomas were associated with longer treatment duration (median = 20 vs 7 years, P = 0.001) and higher cumulative dose (median = 91 g vs. 62 g, P = 0.014). Similarly, their multiplicity was associated with higher dose of CPA (median = 244 g vs 61 g, P = 0.027). Most meningiomas were ≤ 1 cm3 (44/58, 76%) and were convexity meningiomas (36/58, 62%). At diagnosis, patients were non-symptomatic, and all were managed conservatively. Among 14 patients with meningioma who stopped progestin exposure, meningioma burden decreased in 11 (79%) cases with no case of progression during MR follow-up. CONCLUSION Systematic MR screening in progestin-exposed patients uncovers small and multiple meningiomas, which can be managed conservatively, decreasing in size after progestin discontinuation. The high rate of meningiomas after CPA exposure reinforces the need for systematic screening. For NA and CMA, further studies are needed to identify patients most likely to benefit from screening.
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Affiliation(s)
- Thomas Samoyeau
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Corentin Provost
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Alexandre Roux
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Laurence Legrand
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Edouard Dezamis
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Geneviève Plu-Bureau
- Université Paris Cité, Paris, France.,Unité de gynécologie endocrinienne, Hôpital Cochin-Port-Royal, 123 Boulevard Port-Royal, Paris, France.,Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM U1153, Paris, France
| | - Johan Pallud
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France.,Université Paris Cité, Paris, France.,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Joseph Benzakoun
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM U 1266, IMA-BRAIN, Paris, France. .,Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France.
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9
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Passeri T, Giammattei L, Le Van T, Abbritti R, Perrier A, Wong J, Bourneix C, Polivka M, Adle-Biassette H, Bernat AL, Masliah-Planchon J, Mandonnet E, Froelich S. Atypical evolution of meningiomatosis after discontinuation of cyproterone acetate: clinical cases and histomolecular characterization. Acta Neurochir (Wien) 2022; 164:255-263. [PMID: 34613529 DOI: 10.1007/s00701-021-05005-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The long-term use of cyproterone acetate (CPA) is associated with an increased risk of developing intracranial meningiomas. CPA discontinuation most often induces a stabilization or regression of the tumor. The underlying biological mechanisms as well as the reasons why some meningiomas still grow after CPA discontinuation remain unknown. We reported a series of patients presenting CPA-induced meningiomatosis with opposed tumor evolutions following CPA discontinuation, highlighting the underlying histological and genetic features. METHODS Patients presenting several meningiomas with opposite tumor evolution (coexistence of growing and shrinking tumors) following CPA discontinuation were identified. Clinical and radiological data were reviewed. A retrospective volumetric analysis of the meningiomas was performed. All the growing meningiomas were operated. Each operated tumor was characterized by histological and genetic analyses. RESULTS Four women with multiple meningiomas and opposite tumor volume evolutions after CPA discontinuation were identified. Histopathological analysis characterized the convexity and tentorial tumors which continued to grow after CPA discontinuation as fibroblastic meningiomas. The decreasing skull base tumor was characterized as a fibroblastic meningioma with increased fibrosis and a widespread collagen formation. The two growing skull base meningiomas were identified as meningothelial and transitional meningiomas. The molecular characterization found two NF2 mutations among the growing meningiomas and a PIK3CA mutation in the skull base tumor which decreased. CONCLUSION To our knowledge, this is the first report describing an atypical tumor evolution of CPA-associated meningiomas after CPA discontinuation. The underlying biological mechanisms explaining this observation and especially the close relationship between mutational landscapes and embryologic origins of the meninges in CPA-related meningiomas as well as their clonal origin require further research.
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Affiliation(s)
- Thibault Passeri
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France.
- Department of Genetics, Institut Curie, Paris, France.
| | - Lorenzo Giammattei
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | - Tuan Le Van
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | - Rosaria Abbritti
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | | | - Jennifer Wong
- Department of Genetics, Institut Curie, Paris, France
| | | | - Marc Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | - Homa Adle-Biassette
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | | | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Assistance Publique - Hopitaux de Paris, University of Paris, Paris, France
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10
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Devalckeneer A, Aboukais R, Faisant M, Bourgeois P, Quentin VM, Maurage CA, Escande F, Lejeune JP. Progestin-related WHO grade II meningiomas behavior-a single-institution comparative case series. Neurosurg Rev 2021. [PMID: 34850321 DOI: 10.1007/s10143-021-01708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/09/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
WHO grade II progestin-related meningiomas have been reported in recent series but we found no previous study describing their long-term outcome. Our study aimed to evaluate patients operated on for high-grade intracranial meningioma and who underwent long-term exposure to high dose of cyproterone acetate, nomegestrol acetate, and chlormadinone acetate. Our study retrospectively included 9 patients with high-grade progestin-related intracranial meningioma between December 2006 and September 2021. In each patient, clinico-radiological follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. The mean progestative exposure was 11.4 years. Edema existence or absence of cleft sign on MRI were the key factors for surgical indication. All patients underwent surgery. Adjuvant radiotherapy was indicated in 1 patient, and Gamma Knife radiosurgery was proposed in 2 other patients for a second location of meningioma. Six patients harbored a grade II chordoid meningioma subtype with 100% PR expression and 3 patients a grade II atypical meningioma subtype with lower PR expression. The mean follow-up was 8.1 years and none of the 9 patients presented with a recurrence. Patients with grade II progestin-related meningiomas have less tumor recurrence after surgery than patients with sporadic grade II meningiomas, especially after progestin withdrawal. The presence/appearance of peri-meningioma edema and the absence of cleft sign before volumetric change should suggest the existence of an underlying WHO grade II meningiomas. In these cases, surgical resection may immediately be considered and adjuvant radiotherapy should be reserved for proven recurrence cases.
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11
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Burinkul S, Panyakhamlerd K, Suwan A, Tuntiviriyapun P, Wainipitapong S. Anti-Androgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial. J Sex Med 2021; 18:1299-1307. [PMID: 37057417 DOI: 10.1016/j.jsxm.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 01/19/2021] [Revised: 04/12/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spironolactone and cyproterone acetate are commonly used in feminizing hormone therapy to achieve the goal of female range testosterone level; however, the data on the efficacy comparing between these two anti-androgens are scarce. AIM To compare the anti-androgenic effects between spironolactone and cyproterone acetate as the component of feminizing hormone therapy among transgender women population. METHODS The study was single-blinded randomized controlled trial involved 52 transgender women from two transgender health clinics. Each participant received oral estradiol valerate 4 mg/day combined with anti-androgen, spironolactone 100 mg/day or cyproterone acetate 25 mg/day, depending on which group they were randomized to. Clinical and biochemical variables were obtained at baseline and at 12 weeks of feminizing hormone therapy. MAIN OUTCOME MEASURES The change of testosterone level from baseline. Other changes including free testosterone, estradiol, prolactin and lipid profile after the therapy. RESULTS After a 12 weeks of feminizing hormone therapy, the change of testosterone level in the cyproterone acetate group [558.0 ng/dL (IQR 352.0 to 783.3)] was significantly higher than the spironolactone group [226.2 ng/dL (IQR,-4.3 to 480.1)](p value <0.001). Testosterone and calculated free testosterone in the cyproterone acetate group were significantly lower than the spironolactone group. Consequently, a proportion of the participants who achieved the female range testosterone (<50 ng/dL) was significantly higher in cyproterone acetate group (90%) compared to the spironolactone group (19%). Serious adverse effects observed in cyproterone acetate users were drug-induced liver injury and asymptomatic hyperprolactinemia. CLINICAL IMPLICATIONS The data on the differences between the two anti-androgen could be benefit for the transgender health-care providers in medication selection and adverse-effects counseling. STRENGTHS & LIMITATIONS The study design was randomized controlled trial and controlled the estrogen component by prescribed the same type and dose for each participant. However, the study was suffered from the confound feminizing effects from previous hormone therapy and the high drop-out rate. CONCLUSION For feminizing hormone therapy, cyproterone acetate had a higher testosterone suppression efficacy than spironolactone. Burinkul S, Panyakhamlerd K, Suwan A, et al. Anti-Andorgenic Effects Comparison Between Cyproterone Acetate and Spironolactone in Transgender Women: A Randomized Controlled Trial. J Sex Med 2021;18:1299-1307.
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Affiliation(s)
- Supanat Burinkul
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krasean Panyakhamlerd
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Ammarin Suwan
- Division of Gender, Sexual and Climacteric medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Punkavee Tuntiviriyapun
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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12
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Graillon T, Boissonneau S, Appay R, Boucekine M, Peyrière H, Meyer M, Farah K, Albarel F, Morange I, Castinetti F, Brue T, Fuentes S, Figarella-Branger D, Cuny T, Dufour H. Meningiomas in patients with long-term exposition to progestins: Characteristics and outcome. Neurochirurgie 2021; 67:556-563. [PMID: 33989642 DOI: 10.1016/j.neuchi.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe progestin-associated meningiomas' characteristics, outcome and management. MATERIAL AND METHODS We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation. RESULTS Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n=24) and ChlA/NomA (n=11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location. CONCLUSIONS Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.
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Affiliation(s)
- T Graillon
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - S Boissonneau
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neuro-chirurgie, Marseille, France
| | - R Appay
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - M Boucekine
- Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279 CEReSS - Health Service Research and Quality of Life Center, 27, bd Jean Moulin cedex 05, 13385 Marseille, France
| | - H Peyrière
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - M Meyer
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - K Farah
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - F Albarel
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - I Morange
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - F Castinetti
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - T Brue
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - S Fuentes
- Aix Marseille Univ, AP-HM, Department of Neurosurgery, Hospital La Timone, Marseille, France
| | - D Figarella-Branger
- Aix-Marseille Univ, AP-HM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - T Cuny
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Endocrinology, Hospital La Conception, Marseille, France
| | - H Dufour
- Aix Marseille Univ, AP-HM, INSERM, MMG, Department of Neursurgery, CHU Timone, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
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13
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Batchinsky-Parrou V, Barraud S, Kleiber JC, Litre F. First case of cyproterone acetate induced multiple meningiomas in identical female twins: A case report. Neurochirurgie 2021; 68:323-326. [PMID: 33989640 DOI: 10.1016/j.neuchi.2021.04.021] [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: 11/01/2020] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
Meningiomas are the most common tumors of the central nervous system. Most meningiomas are benign and occur mainly in middle-aged women. Only a few cases of meningiomas in identical twins have been reported. Cyproterone acetate (Androcur® Bayer Healthcare SAS) (CPA) is an antiandrogenic progestin used to treat female hirsutism in some countries including France. We report a case of identical twin sisters who developed multiple, atypically located meningiomas in the setting of long-term CPA use. Eighteen-month follow-up showed spontaneous decrease of meningiomas after cessation of CPA. This case illustrates CPA's ability to induce development of atypically located meningiomas that differ even between identical twins, confirms benefit of surgical abstention, and raises questions regarding security of use of CPA.
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Affiliation(s)
- V Batchinsky-Parrou
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France.
| | - S Barraud
- Endocrinology University Hospital Reims, Reims, France
| | - J C Kleiber
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France
| | - F Litre
- Neurosurgery University Hospital Reims, 45, rue de Cognacq Jay, 51092 Reims, France
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14
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Raven LM, Guttman-Jones M, Muir CA. Hyperprolactinemia and association with prolactinoma in transwomen receiving gender affirming hormone treatment. Endocrine 2021; 72:524-528. [PMID: 33398769 DOI: 10.1007/s12020-020-02563-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/22/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Approximately 0.6% of the adult population identifies as transgender. Gender affirming hormone treatment (GAHT) is required by many to develop physical and psychological characteristics that align with their gender identity. Once started, GAHT is continued lifelong and at higher doses than conventionally used in the management of cis-gendered women. Hyperprolactinemia and pituitary lactotroph adenomas are a potential consequence of GAHT. METHODS Case series of three transfeminine women with hyperprolactinemia during gender affirming hormone treatment. RESULTS We report two new cases of prolactinoma and one new case of marked hyperprolactinemia without pituitary adenoma associated with GAHT in transwomen at different stages of hormonal transition. Novel aspects of our case series include the first report of a prolactinoma in a transwoman associated with spironolactone and the alternate progestin medroxyprogesterone acetate and documentation of the transient changes in prolactin from baseline (prior to feminizing hormones) in two transwomen which demonstrate that marked hyperprolactinemia develops early in the course of GAHT. CONCLUSIONS Transgender women receiving GAHT may be at increased risk for prolactinoma. As the number of transwomen seeking GAHT continues to increase, hyperprolactinemia and GAHT-associated prolactinoma may become an increasingly important component of endocrine practice. Screening of prolactin levels in transwomen receiving GAHT could potentially prevent morbidity related to hyperprolactinemia and allow for early detection of prolactin secreting pituitary adenomas.
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Affiliation(s)
- Lisa M Raven
- Department of Endocrinology, St. Vincent's Hospital, Sydney, NSW, Australia
| | | | - Christopher A Muir
- Department of Endocrinology, St. Vincent's Hospital, Sydney, NSW, Australia.
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15
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Malaize H, Samoyeau T, Zanello M, Roux A, Benzakoun J, Peeters S, Zah-Bi G, Edjlali M, Tauziede-Espariat A, Dezamis E, Parraga E, Chrétien F, Varlet P, Plu-Bureau G, Oppenheim C, Pallud J. Evolution of the neurosurgical management of progestin-associated meningiomas: a 23-year single-center experience. J Neurooncol 2021; 152:279-288. [PMID: 33449307 DOI: 10.1007/s11060-021-03696-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 11/19/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The improving knowledge of interactions between meningiomas and progestin refines the management of this specific condition. We assessed the changes over time of the management of progestin-associated meningiomas. METHODS We retrospectively studied consecutive adult patients who had at least one meningioma in the context of progestin intake (October 1995-October 2018) in a tertiary adult Neurosurgical Center. RESULTS 71 adult women with 125 progestin-associated meningiomas were included. The number of progestin-associated meningioma patients increased over time (0.5/year before 2008, 22.0/year after 2017). Progestin treatment was an approved indication in 27.0%. A mean of 1.7 ± 1.2 meningiomas were discovered per patient (median 1, range 1-6). Surgery was performed on 36 (28.8%) meningiomas and the histopathologic grading was WHO grade 1 in 61.1% and grade 2 in 38.9%. The conservative management of meningiomas increased over time (33.3% before 2008, 64.3% after 2017) and progestin treatment withdrawal increased over time (16.7% before 2008, 95.2% after 2017). Treatment withdrawal varied depending on the progestin derivative used (88.9% with cyproterone acetate, 84.6% with chlormadinone acetate, 28.6% with nomegestrol acetate, 66.7% with progestin derivative combination). The main reason for therapeutic management of meningiomas was the presence of clinical signs. Among the 54 meningiomas managed conservatively for which the progestin had been discontinued, MRI follow-up demonstrated a regression in 29.6%, a stability in 68.5%, and an ongoing growth in 1.9% of cases. CONCLUSIONS Conservative management, including progestin treatment discontinuation, has grown over time with promising results in terms of efficacy and safety.
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Affiliation(s)
- Henri Malaize
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Thomas Samoyeau
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Joseph Benzakoun
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Gilles Zah-Bi
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Myriam Edjlali
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | | | - Edouard Dezamis
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
| | - Fabrice Chrétien
- Université de Paris, Paris, France
- Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Pascale Varlet
- Université de Paris, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
- Department of Neuropathology, GHU site Sainte-Anne, Paris, France
| | - Geneviève Plu-Bureau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, INSERM U1153, Paris-Descartes University, Paris, France
- Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, APHP, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Paris, France
- Department of Neuroradiology, GHU site Sainte-Anne, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, Service de Neurochirurgie, GHU site Sainte-Anne, Paris, France.
- Université de Paris, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, Paris, France.
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Samarut E, Lugat A, Amelot A, Scharbarg E, Hadjadj S, Primot C, Loussouarn D, Thillays F, Buffenoir K, Cariou B, Drui D, Roualdes V. Meningiomas and cyproterone acetate: a retrospective, monocentric cohort of 388 patients treated by surgery or radiotherapy for intracranial meningioma. J Neurooncol 2021; 152:115-123. [PMID: 33392938 DOI: 10.1007/s11060-020-03683-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/14/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Meningiomas are the most common intracranial tumors, accounting for 20-30% of central nervous system tumors. Recently, the European Medicines Agency issued an alert on cyproterone acetate (CPA) based on the results of a study that found an increased risk of meningioma 7 to 20 times higher when a patient is on CPA. The primary objective of this study was to determine the prevalence of CPA exposure in patients who had one or more intracranial meningiomas treated surgically or with radiation therapy. The secondary objectives were to establish a description of the patients who had intracranial meningioma in Nantes and to establish whether there was a difference in the intrinsic and tumoral characteristics of patients exposed to CPA compared with patients who had no hormonal exposure and patients who had been exposed to other hormones. METHODS Monocentric, retrospective study including all patients treated by surgery or radiotherapy for intracranial meningioma from 2014 to 2017 excluding those with a history of exposure to ionizing radiation or neurofibromatosis type 2. RESULTS 388 patients were included, 277 were treated by surgery and 111 by radiotherapy. 3.9% of the patients had a history or current use of CPA, 16.2% were taking other hormonal treatment. Compared with the group without hormonal exposure, the CPA-exposed group had significantly an earlier onset of meningiomas at 48.9 vs. 61.9 years (p = 0.0005) and had more multiple meningiomas, 26.7% vs. 6.1% (p = 0.0115). CONCLUSIONS In our study, patients with a history or current use of CPA had significantly more meningiomas and were significantly younger at the onset.
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Affiliation(s)
- Edouard Samarut
- Neurotraumatology, Neurosurgery Department, Hotel-Dieu, CHU Nantes, Nantes, France
| | - Alexandre Lugat
- L'institut du thorax, Endocrinology, Diabetology and Nutrition Department, CHU Nantes, Nantes, France
- Inserm UMR 1232, CRCINA, Université d'Angers, Université de Nantes, Nantes, France
| | - Aymeric Amelot
- Neurosurgery Department, Bretonneau Hospital, CHRU Tours, Tours, France
- Inserm UMR 1253, Université de Tours, Tours, France
| | - Emeric Scharbarg
- L'institut du thorax, Endocrinology, Diabetology and Nutrition Department, CHU Nantes, Nantes, France
| | - Samy Hadjadj
- L'institut du thorax, Endocrinology, Diabetology and Nutrition Department, CHU Nantes, Nantes, France
| | - Claire Primot
- Inserm UMR 1413, CIC, Endocrinology, Diabetology and Nutrition, CHU Nantes, Nantes, France
| | | | - François Thillays
- Radiotherapy Department, Institut de Cancérologie de l'Ouest (ICO), Saint-Herblain, France
| | - Kevin Buffenoir
- Neurotraumatology, Neurosurgery Department, Hotel-Dieu, CHU Nantes, Nantes, France
| | - Bertrand Cariou
- L'institut du thorax, Endocrinology, Diabetology and Nutrition Department, CHU Nantes, Nantes, France
| | - Delphine Drui
- L'institut du thorax, Endocrinology, Diabetology and Nutrition Department, CHU Nantes, Nantes, France.
| | - Vincent Roualdes
- Neurotraumatology, Neurosurgery Department, Hotel-Dieu, CHU Nantes, Nantes, France.
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17
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Alshahrani A. Using cyproterone acetate to treat recurrent ischemic priapism in a patient with sickle cell anemia as a comorbidity: a case report. J Med Case Rep 2020; 14:197. [PMID: 33081822 PMCID: PMC7576868 DOI: 10.1186/s13256-020-02527-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The management of recurrent ischemic priapism is unclear in contemporary practice. Yet, if left untreated, the condition may evolve into an acute ischemic priapism and in some cases result in erectile dysfunction. This report documents the results of successful management of recurrent ischemic priapism using cyproterone acetate in a 30-year-old Saudi man with sickle cell anemia as a comorbidity. Case presentation A 30-year-old Saudi man denoted visited the emergency room with a painful erection which had lasted for more than four hours. The patient has sickle cell anemia and a family history of sickle cell disease. He is married and has two children. His first priapism case occurred when he was 7 years old. At the age of 15, the condition recurred, and the patient’s doctor prescribed cyproterone acetate 50 mg twice daily for 5 days. The doctor had told him that whenever he was experiencing priapism, he should adhere to this regimen for 5 days. The doctor could not find any guidelines for the prescription of cyproterone acetate. Conclusion Priapism cases represent a significant challenge in therapeutic management because of the elevated risk of structural damage to the penis. The fact that there lacks a clinically approved standard approach to managing the condition make it difficult for physicians to effectively manage the condition. Management of the condition is further complicated by existence of comorbidities such as sickle cell anemia. This patient’s case demonstrates that cyproterone acetate prescription is a great preventative strategy that limits priapism recurrences.
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Affiliation(s)
- Ali Alshahrani
- Clinical Pharmacy, Pharmacy College, Taif University, P.O. Box 888, Haweiah, 21974, Saudi Arabia.
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18
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Gómez Á, Cerdán S, Pérez-Laso C, Ortega E, Pásaro E, Fernández R, Gómez-Gil E, Mora M, Marcos A, Del Cerro MCR, Guillamon A. Effects of adult male rat feminization treatments on brain morphology and metabolomic profile. Horm Behav 2020; 125:104839. [PMID: 32800765 DOI: 10.1016/j.yhbeh.2020.104839] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
Body feminization, as part of gender affirmation process of transgender women, decreases the volume of their cortical and subcortical brain structures. In this work, we implement a rat model of adult male feminization which reproduces the results in the human brain and allows for the longitudinal investigation of the underlying structural and metabolic determinants in the brain of adult male rats undergoing feminization treatments. Structural MRI and Diffusion Tensor Imaging (DTI) were used to non-invasively monitor in vivo cortical brain volume and white matter microstructure over 30 days in adult male rats receiving estradiol (E2), estradiol plus cyproterone acetate (CA), an androgen receptor blocker and antigonadotropic agent (E2 + CA), or vehicle (control). Ex vivo cerebral metabolic profiles were assessed by 1H High Resolution Magic Angle Spinning NMR (1H HRMAS) at the end of the treatments in samples from brain regions dissected after focused microwave fixation (5 kW). We found that; a) Groups receiving E2 and E2 + CA showed a generalized bilateral decrease in cortical volume; b) the E2 + CA and, to a lesser extent, the E2 groups maintained fractional anisotropy values over the experiment while these values decreased in the control group; c) E2 treatment produced increases in the relative concentration of brain metabolites, including glutamate and glutamine and d) the glutamine relative concentration and fractional anisotropy were negatively correlated with total cortical volume. These results reveal, for the first time to our knowledge, that the volumetric decreases observed in trans women under cross-sex hormone treatment can be reproduced in a rat model. Estrogens are more potent drivers of brain changes in male rats than anti-androgen treatment.
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Affiliation(s)
- Ángel Gómez
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain
| | - Sebastián Cerdán
- Instituto de Investigaciones Biomédicas "Alberto Sols", Consejo Superior de Investigaciones Científicas, 28029 Madrid, Spain
| | - Carmen Pérez-Laso
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Esperanza Ortega
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Granada, 18016 Granada, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Rosa Fernández
- Departamento de Psicología, Universidade da Coruña, 15071 A Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Departamento de Psiquiatría, Hospital Clínic, 08036 Barcelona, Spain
| | - Mireia Mora
- Departamento de Endocrinología, Hospital Clínic, 08036 Barcelona, Spain
| | - Alberto Marcos
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - María Cruz Rodríguez Del Cerro
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de educación a Distancia, 28040 Madrid, Spain.
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Apra C, Roblot P, Alkhayri A, Le Guérinel C, Polivka M, Chauvet D. Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas. J Neurooncol 2020; 149:95-101. [PMID: 32705456 DOI: 10.1007/s11060-020-03576-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The great heterogeneity of meningiomas is challenging and we need to distinguish relevant subgroups. Spheno-orbital osteomeningiomas (SOOM) constitute a clinically specific entity, with slow-growing benign osteo-meningiomatous tumors, which recur after surgery in one fourth of cases. Neurosurgical daily practice, supported by the literature, shows that the vast majority of patients with SOOM are women, and we explored whether their epidemiological and hormonal profiles suggest a progesterone influence. METHODS We retrospectively documented all radiologically and histologically confirmed cases of SOOM operated in 2005-2019 in our institution. We completed the clinical and hormone history by systematic telephone interviews. RESULTS In the literature, SOOM occur significantly more often in women than other meningiomas (749/847, 86.4% versus 73.8%, p = 0.002). Among 175 cases, we included 124 patients, 93.5% were women, younger than men (51 ± 5 versus 63 ± 8, p = 0.02). Women' meningiomas showed more progesterone receptors (96.4% versus 50%, p < 0.001). Exogenous hormonal intake, reliable in 82 cases, concerned 83.3% (64/78) of women, with frequent progesterone intake: 13 oestroprogestogenic treatment only, with old-generation progesterone analogs, 41 progesterone analogs (cyproterone acetate, nomegestrol acetate, chlormadinone, promegestone, etonogestrel, levonogestrel), 7 substitutive hormonal therapy for menopause, 3 others. Duration of treatment was 2-40 years, median 10 years. CONCLUSIONS SOOM develop preferentially in women in their fifties, who often received progesterone analogs, and show progesterone receptors. Progesterone analogs are incriminated in skull base meningiomas, and this is the first report on the prevalence of exogenous hormone therapy specifically in SOOM. Whether SOOM reduce after treatment discontinuation, in particular the osteoma part, needs to be explored. Anti-progesterone treatments may represent an avenue for future research in soom.
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Portet S, Banor T, Bousquet J, Simonneau A, Flores M, Ingrand P, Milin S, Karayan-Tapon L, Bataille B. New Insights into Expression of Hormonal Receptors by Meningiomas. World Neurosurg 2020; 140:e87-e96. [PMID: 32371078 DOI: 10.1016/j.wneu.2020.04.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/06/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Meningiomas have a female predilection, which is even stronger for spinal than for intracranial meningiomas. The relationship between meningiomas and endogenous or exogenous sex hormones such as cyproterone acetate (CPA) is well documented, yet their underlying mechanism remains unknown. Clarification of the expression profile of hormonal receptors by meningiomas would help us to better understand their hormonal susceptibility. METHODS We used tissue microarray and immunohistochemistry to determine the receptor status of the 3 main sex hormones: androgen (AR), estrogen, and progesterone (PR) in 30 intracranial meningiomas, 30 spinal meningiomas, and 30 meningiomas developed on CPA. RESULTS AR status was positive in 73% of meningiomas in the intracranial group, 87% of meningiomas in the CPA group, and in all meningiomas in the spinal group. Estrogen status was positive in only 7% of meningiomas in the intracranial group and in only 3% of meningiomas in the CPA group but in 30% of meningiomas in the spinal group. PR status was positive in 90% of meningiomas in the intracranial group, in 97% of meningiomas in the CPA group, and in 87% of meningiomas in the spinal group. These specific hormonal receptor statuses based on immunoreactive score were reflected on staining intensities. Furthermore, AR and PR expression was correlated in each group. CONCLUSIONS Our study shows that intracranial meningiomas, spinal meningiomas, and meningiomas developed on CPA express specific hormonal receptor patterns. This result invites the scientific community to review the potential role of AR in the unbalanced sex ratio of meningiomas.
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Affiliation(s)
- Sylvain Portet
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Neurosurgery, University Hospital of Poitiers, Poitiers, France.
| | - Tania Banor
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Neurosurgery, University Hospital of Poitiers, Poitiers, France
| | - Jonathan Bousquet
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Neurosurgery, University Hospital of Poitiers, Poitiers, France
| | - Adrien Simonneau
- Department of Neurosurgery, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Marie Flores
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Pierre Ingrand
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Statistics, University Hospital of Poitiers, Poitiers, France
| | - Serge Milin
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Lucie Karayan-Tapon
- Faculty of Medicine, University of Poitiers, Poitiers, France; INSERM 1084, Experimental and Clinical Neurosciences Laboratory, University of Poitiers, Poitiers, France; Department of Cancer Biology, University Hospital of Poitiers, Poitiers, France
| | - Benoit Bataille
- Faculty of Medicine, University of Poitiers, Poitiers, France; Department of Neurosurgery, University Hospital of Poitiers, Poitiers, France
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Roux A, Tauziede-Espariat A, Zanello M, Gareton A, Malaize H, Benzakoun J, Zah-Bi G, Oppenheim C, Plu-Bureau G, Chretien F, Pallud J. Symptomatic progestin-associated atypical grade II meningioma. A first case report. Neurochirurgie 2020; 66:174-178. [PMID: 32277999 DOI: 10.1016/j.neuchi.2019.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/14/2019] [Revised: 11/24/2019] [Accepted: 12/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Long-term use of high-dose progestin is known to promote the development of meningioma. Atypical meningioma in a patient under progestin has not previously been reported. CASE REPORT A 53-year-old right-handed woman presented with focal onset seizures, without impaired consciousness. Medical history featured endometriosis, treated successively by cyproterone acetate 25mg/day for 2 months then 50mg/day for 101 months, and chlormadinone acetate 5mg/day for 68 months then 10mg/day for 83 months. Brain MRI revealed multiple extra-axial lesions suggestive of left central meningioma associated with anterior skull base meningiomatosis. Surgical resection of the left central meningioma was achieved and progestin was withdrawn. Neuropathology diagnosed grade II atypical meningioma. Close clinical and imaging monitoring was implemented without adjuvant oncological treatment. At 25 months, imaging follow-up showed no recurrence of the left central meningioma and a significant regression of all other lesions, except for the right frontal lesion. CONCLUSIONS Neurosurgeons should be aware of the possible aggressiveness of meningioma in patients under progestin, and particularly those treated by different types of progestin over a long period of time without interruption. This may require systematic close monitoring, to adapt neurosurgical management.
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Affiliation(s)
- A Roux
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Tauziede-Espariat
- Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - M Zanello
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - A Gareton
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - H Malaize
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - J Benzakoun
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Zah-Bi
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - C Oppenheim
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuroradiology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - G Plu-Bureau
- INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, AP-HP, Paris, France
| | - F Chretien
- Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France
| | - J Pallud
- Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
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Zubizarreta L, Silva AC, Quintana L. The estrogenic pathway modulates non-breeding female aggression in a teleost fish. Physiol Behav 2020; 220:112883. [PMID: 32199998 DOI: 10.1016/j.physbeh.2020.112883] [Citation(s) in RCA: 14] [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] [Received: 02/11/2020] [Revised: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
Aggressive behaviors are widespread among animals and are critical in the competition for resources. The physiological mechanisms underlying aggression have mostly been examined in breeding males, in which gonadal androgens, acting in part through their aromatization to estrogens, have a key role. There are two alternative models that contribute to further understanding hormonal mechanisms underlying aggression: aggression displayed in the non-breeding season, when gonadal steroids are low, and female aggression. In this study we approach, for the first time, the modulatory role of estrogens and androgens upon non-breeding aggression in a wild female teleost fish. We characterized female aggression in the weakly electric fish Gymnotus omarorum and carried out acute treatments 1 h prior to agonistic encounters in dyads treated with either an aromatase inhibitor or an antagonist of androgen receptors. Anti-androgen treatment had no effect on behavior whereas acute aromatase inhibition caused a strong distortion of aggressive behavior. Territorial non-breeding aggression was robust and depended on rapid estrogen actions to maintain high levels of aggression, and ultimately reach conflict resolution from which dominant/subordinate status emerged. Our results, taken together with our own reports in males and the contributions from non-breeding aggression in bird and mammal models, suggest a common strategy involving fast-acting estrogens in the control of this behavior across species. In addition, further analysis of female non-breeding aggression may shed light on potential sexual differences in the fine tuning of social behaviors.
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Affiliation(s)
- Lucía Zubizarreta
- Laboratorio de Neurofisiología Celular y Sináptica, Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Avenida Gral. Flores 2125, Montevideo, Uruguay; Unidad Bases Neurales de la Conducta, Departamento de Neurofisiología Celular y Molecular, Instituto de Investigaciones Biológicas Clemente Estable, Avenida Italia 3318, Montevideo, Uruguay
| | - Ana C Silva
- Unidad Bases Neurales de la Conducta, Departamento de Neurofisiología Celular y Molecular, Instituto de Investigaciones Biológicas Clemente Estable, Avenida Italia 3318, Montevideo, Uruguay; Laboratorio de Neurociencias, Facultad de Ciencias, Universidad de la República, Iguá 4225, 11400 Montevideo, Uruguay
| | - Laura Quintana
- Unidad Bases Neurales de la Conducta, Departamento de Neurofisiología Celular y Molecular, Instituto de Investigaciones Biológicas Clemente Estable, Avenida Italia 3318, Montevideo, Uruguay.
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Broux E, Dewailly D, Catteau-Jonard S. [Spironolactone as a relay for cyproterone acetate in hyperandrogenic women]. Gynecol Obstet Fertil Senol 2020; 48:181-186. [PMID: 31926311 DOI: 10.1016/j.gofs.2020.01.001] [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] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Cyproterone acetate is actually the first-line anti-androgenic treatment for severe hyperandrogenism in women. However, as this treatment is currently controversial, the objective of the study was to evaluate the safety and efficacy of spironolactone as a relay for cyproterone acetate. METHODS This is a monocentric retrospective study conducted between December 2002 and January 2018 at the Jeanne de Flandre Hospital at the University Hospital Center of Lille. Patients with clinical hyperandrogenism who received treatment with cyproterone acetate and then spironolactone were included. A total of 37 patients were clinically and biologically evaluated before treatment, followed by cyproterone acetate and spironolactone. RESULTS Clinically, the vast majority of patients were satisfied with the relay by spironolactone and found no difference between the two treatments. Biologically, testosterone and delta-4 androstenedione levels were significantly decreased with cyproterone acetate and spironolactone compared to no treatment. No significant differences were found when comparing levels under cyproterone acetate and under spironolactone. In addition, 87,5% of patients were free of side effects. CONCLUSIONS The data collected show the clinical and biological efficacy of spironolactone as a relay for cyproterone acetate in the treatment of hyperandrogenism. This anti-androgen therefore appears as an effective and well-tolerated alternative, as a relay for cyproterone acetate in patients with hyperandrogenism.
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Affiliation(s)
- E Broux
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; Service d'assistance médicale à la procréation, CH Calais, 1601, boulevard des Justes, 62100 Calais, France.
| | - D Dewailly
- University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
| | - S Catteau-Jonard
- University Lille, CHU de Lille, service de gynécologie médicale, 59000 Lille, France; University Lille, CHU de Lille, Inserm U1172, 59000 Lille, France.
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Passeri T, Champagne PO, Bernat AL, Hanakita S, Salle H, Mandonnet E, Froelich S. Spontaneous regression of meningiomas after interruption of nomegestrol acetate: a series of three patients. Acta Neurochir (Wien) 2019; 161:761-765. [PMID: 30783806 DOI: 10.1007/s00701-019-03848-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The relationship between increased meningioma incidence and growth and long-term hormonal therapy with cyproterone acetate (CPA) in women has been recently established in literature. Following the raise in awareness from hormonal treatment, we describe a potential relationship between the progesterone agonist nomegestrol acetate (NOMAC) and meningioma growth. METHODS After implementation of a screening protocol to detect potential interactions between hormonal exposure and occurrence of meningioma, we identified patients taking NOMAC and newly diagnosed with a meningioma. NOMAC was stopped and those patients were followed tightly both clinically and radiologically. Retrospective volumetric analysis of the tumors was performed on the imaging. RESULTS Three patients were identified for the study. After cessation of the NOMAC, tumor shrinkage was documented for all meningiomas within the first month. Up to 70% of tumor volume reduction was observed during the first year of follow-up in one of them. None of the patients developed new symptoms. CONCLUSION We report the first cases of meningiomas responsiveness to discontinuation of hormonal therapy with NOMAC. Similarly to cases associated with long-term CPA intake, tumor reduction, and improvement of clinical symptoms can be observed after cessation of NOMAC.
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Champagne PO, Passeri T, Froelich S. Combined hormonal influence of cyproterone acetate and nomegestrol acetate on meningioma: a case report. Acta Neurochir (Wien) 2019; 161:589-92. [PMID: 30666456 DOI: 10.1007/s00701-018-03782-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022]
Abstract
Cyproterone acetate (CPA) is an antiandrogenic drug which has recently been recognized to promote the occurrence and growth of intracranial meningiomas. Nomegestrol acetate (NOMAC) is a widely used progestin-like drug that could be suggested as an alternative for patients taking CPA. We report a case of CPA-related meningioma for which relay from CPA to NOMAC led to further tumor growth and cessation of NOMAC-induced tumor shrinkage. We suggest NOMAC can have a similar effect than CPA on meningiomas. The use of NOMAC as replacement for CPA in the presence of a meningioma should be discouraged until further evidence becomes available on the role of NOMAC in such instances.
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Nejabat M, Riegler T, Reitinger T, Subosits S, Römer M, Eichner J, Bilban M, Zell A, Huber WW, Schulte-Hermann R, Grasl-Kraupp B. Mesenchyme-derived factors enhance preneoplastic growth by non-genotoxic carcinogens in rat liver. Arch Toxicol 2018; 92:953-66. [PMID: 29270806 DOI: 10.1007/s00204-017-2080-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/11/2017] [Accepted: 09/21/2017] [Indexed: 02/01/2023]
Abstract
Many frequently prescribed drugs are non-genotoxic carcinogens (NGC) in rodent liver. Their mode of action and health risks for humans remain to be elucidated. Here, we investigated the impact of two model NGC, the anti-epileptic drug phenobarbital (PB) and the contraceptive cyproterone acetate (CPA), on intrahepatic epithelial–mesenchymal crosstalk and on growth of first stages of hepatocarcinogenesis. Unaltered hepatocytes (HC) and preneoplastic HC (HCPREN) were isolated from rat liver for primary culture. DNA replication of HC and HCPREN was increased by in vitro treatment with 10 µM CPA, but not 1 mM PB. Next, mesenchymal cells (MC) obtained from liver of rats treated with either PB (50 mg/kg bw/day) or CPA (100 mg/kg bw/day), were cultured. Supernatants from both types of MC raised DNA synthesis of HC and HCPREN. This indicates that PB induces replication of HC and HCPREN only indirectly, via growth factors secreted by MC. CPA, however, acts on HC and HCPREN directly as well as indirectly via mesenchymal factors. Transcriptomics and bio-informatics revealed that PB and CPA induce extensive changes in the expression profile of MC affecting many growth factors and pathways. MC from PB-treated rats produced and secreted enhanced levels of HBEGF and GDF15, factors found to suppress apoptosis and/or induce DNA synthesis in cultured HC and HCPREN. MC from CPA-treated animals showed enhanced expression and secretion of HGF, which strongly raised DNA replication of HC and HCPREN. In conclusion, our findings reveal profound effects of two prototypical NGC on the hepatic mesenchyme. The resulting release of factors, which suppress apoptosis and/or enhance cell replication preferentially in cancer prestages, appears to be crucial for tumor promotion by NGC in the liver.
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Grandi G, Toss A, Cagnacci A, Marcheselli L, Pavesi S, Facchinetti F, Cascinu S, Cortesi L. Combined Hormonal Contraceptive Use and Risk of Breast Cancer in a Population of Women With a Family History. Clin Breast Cancer 2017; 18:e15-e24. [PMID: 29150351 DOI: 10.1016/j.clbc.2017.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 07/31/2017] [Revised: 10/08/2017] [Accepted: 10/18/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND We estimated the association between combined hormonal contraceptive (CHC) use and breast cancer (BC) incidence in a well-selected population of women at familial risk of BC at the Modena Family Cancer Clinic. MATERIALS AND METHODS We performed a retrospective cohort study by reviewing the data from 2527 women (4.5% BRCA mutation carriers, 72.2% high risk, and 23.3% intermediate risk using the Modena criteria and the Tyrer-Cuzick model). RESULTS We did not find any specific feature of breast cancer (infiltration, hormone receptor and HER2 status, onset before age 35 years, multiple diagnoses) in the CHC users (P > .05). Only 2.0% of women used a preparation with ≥ 50 μg of ethinylestradiol (EE). The use of CHCs was not associated with an increased risk of breast cancer (cumulative hazard: never used, 0.17; CHC users, 0.20; P = .998), regardless of the duration of use (cumulative hazard: never used, 0.17, used < 5 years, 0.20; used 5-10 years, 0.14; used > 10 years, 0.25; P = .414). This was confirmed for the different risk groups when interacted in a Cox proportional hazard regression model. The EE dose did not influence the risk of BC (cumulative hazard, 2.37; 95% confidence interval, 0.53-10.1; never used, 0.18; EE < 20 μg used, 0.04; EE ≥ 20 μg used, 0.16; P = .259). The types of progestins used might influence the risk, with some, such as gestodene (P = .028) and cyproterone acetate (P = .031), associated with an even greater reduced risk. CONCLUSIONS CHC use does not increase the risk of BC in a population of women with a family history, encouraging CHC use in this group of women.
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Affiliation(s)
- Giovanni Grandi
- Department of Obstetrics, Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy.
| | - Angela Toss
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Angelo Cagnacci
- Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Luigi Marcheselli
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Pavesi
- Department of Obstetrics, Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Department of Obstetrics, Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Modena, Italy
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Gismondi E, Fivet A, Joaquim-Justo C. Effects of cyproterone acetate and vertically transmitted microsporidia parasite on Gammarus pulex sperm production. Environ Sci Pollut Res Int 2017; 24:23417-23421. [PMID: 28905182 DOI: 10.1007/s11356-017-0162-4] [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] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
Endocrine disruption compounds (EDCs) and parasitism can both interfere with the reproduction process of organisms. The amphipod Gammarus pulex is the host of the vertically transmitted microsporidia Dictyocoela duebenum, and this work was devoted to the investigation of the effect of an exposure to the anti-androgen compound, cyproterone acetate (CPA), and/or of the presence of D. duebenum on the spermatozoa production and length. Significant reduction of the spermatozoa production was observed when G. pulex males were uninfected and exposed to CPA. There also appeared a lower number of spermatozoa when D. duebenum infects G. pulex, whatever the exposure condition. Moreover, we highlighted that CPA has no effect on spermatozoa production when males are infected by D. duebenum, and no treatment has impacted the spermatozoa length. Our results suggest CPA and D. duebenum could impact the endocrine system of G. pulex and especially processes close to the spermatozoa production (e.g., androgenic gland, androgen gland hormone released, gonad-inhibiting hormone synthesized by X-organ). However, as no mechanism of action was highlighted, further testing need to be performed to improve the understanding of their impacts. Finally, results confirm that vertically transmitted microsporidia could be a confounding factor in the endocrine disruption assessments in Gammaridae.
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Affiliation(s)
- Eric Gismondi
- Laboratory of Animal Ecology and Ecotoxicology (LEAE) - Freshwater and OceaniC sciences Unit of reSearch (FOCUS), Chemistry Institute, University of Liège, Bât. B6C, 11 allée du 6 Août, B-4000, Sart-Tilman, Belgium.
| | - Adeline Fivet
- Laboratory of Animal Ecology and Ecotoxicology (LEAE) - Freshwater and OceaniC sciences Unit of reSearch (FOCUS), Chemistry Institute, University of Liège, Bât. B6C, 11 allée du 6 Août, B-4000, Sart-Tilman, Belgium
| | - Célia Joaquim-Justo
- Laboratory of Animal Ecology and Ecotoxicology (LEAE) - Freshwater and OceaniC sciences Unit of reSearch (FOCUS), Chemistry Institute, University of Liège, Bât. B6C, 11 allée du 6 Août, B-4000, Sart-Tilman, Belgium
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Chen L, Wolff DW, Xie Y, Lin MF, Tu Y. Cyproterone acetate enhances TRAIL-induced androgen-independent prostate cancer cell apoptosis via up-regulation of death receptor 5. BMC Cancer 2017; 17:179. [PMID: 28270124 PMCID: PMC5341373 DOI: 10.1186/s12885-017-3153-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/26/2016] [Accepted: 02/22/2017] [Indexed: 02/07/2023] Open
Abstract
Background Virtually all prostate cancer deaths occur due to obtaining the castration-resistant phenotype after prostate cancer cells escaped from apoptosis and/or growth suppression initially induced by androgen receptor blockade. TNF-related apoptosis-inducing ligand (TRAIL) was an attractive cancer therapeutic agent due to its minimal toxicity to normal cells and remarkable apoptotic activity in tumor cells. However, most localized cancers including prostate cancer are resistant to TRAIL-induced apoptosis, thereby creating a therapeutic challenge of inducing TRAIL sensitivity in cancer cells. Herein the effects of cyproterone acetate, an antiandrogen steroid, on the TRAIL-induced apoptosis of androgen receptor-negative prostate cancer cells are reported. Methods Cell apoptosis was assessed by both annexin V/propidium iodide labeling and poly (ADP-ribose) polymerase cleavage assays. Gene and protein expression changes were determined by quantitative real-time PCR and western blot assays. The effect of cyproterone acetate on gene promoter activity was determined by luciferase reporter assay. Results Cyproterone acetate but not AR antagonist bicalutamide dramatically increased the susceptibility of androgen receptor-negative human prostate cancer PC-3 and DU145 cells to TRAIL-induced apoptosis but no effects on immortalized human prostate stromal PS30 cells and human embryonic kidney HEK293 cells. Further investigation of the TRAIL-induced apoptosis pathway revealed that cyproterone acetate exerted its effect by selectively increasing death receptor 5 (DR5) mRNA and protein expression. Cyproterone acetate treatment also increased DR5 gene promoter activity, which could be abolished by mutation of a consensus binding domain of transcription factor CCAAT-enhancer-binding protein homologous protein (CHOP) in the DR5 gene promoter. Cyproterone acetate increases CHOP expression in a concentration and time-dependent manner and endoplasmic reticulum stress reducer 4-phenylbutyrate could block cyproterone acetate-induced CHOP and DR5 up-regulation. More importantly, siRNA silencing of CHOP significantly reduced cyproterone acetate-induced DR5 up-regulation and TRAIL sensitivity in prostate cancer cells. Conclusions Our study shows a novel effect of cyproterone acetate on apoptosis pathways in prostate cancer cells and raises the possibility that a combination of TRAIL with cyproterone acetate could be a promising strategy for treating castration-resistant prostate cancer. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3153-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Linjie Chen
- Department of Pharmacology, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Dennis W Wolff
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Yan Xie
- Department of Pharmacology, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Ming-Fong Lin
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yaping Tu
- Department of Pharmacology, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA.
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Bernat AL, Oyama K, Hamdi S, Mandonnet E, Vexiau D, Pocard M, George B, Froelich S. Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients. Acta Neurochir (Wien) 2015; 157:1741-6. [PMID: 26264069 DOI: 10.1007/s00701-015-2532-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The relationship between meningiomas and exogenous sex hormones is well known, but cyproterone acetate (CA), a progesterone agonist, seems to have a stronger influence on tumor growth. OBJECTIVE To show the close relationship between CA treatment and meningioma growth. METHODS Since 2010, all patients referred to our clinic for a suspicion of meningioma were questioned specifically about exogenous sex hormone intake and more specifically about CA intake. Twelve patients harboring one or multiple meningiomas and treated with CA were identified. CA was stopped in all cases. Tumor volumes and diameters were measured on serial MRIs and compared to the last MRI before CA withdrawal. RESULTS Ten patients with multiple tumors had been taking the drug for a longer period of time (mean of 20.4 years) than the two patients with one tumor (10 years). Two patients with multiple tumors underwent surgery because of rapidly decreased visual acuity at the time of diagnosis. Discontinuation of CA led to tumor shrinkage in 11 patients and a stop in tumor growth in one [mean tumor volume reduction was around 10 cm(3)/year; range (0.00; 76)]. There was no regrowth during a mean follow-up period of 12 months (range: 5-35). CONCLUSION For patients diagnosed with a meningioma and treated with CA, medication withdrawal followed by observation should be the first line of treatment. Care should be taken with long-term use of high doses of CA, and serial brain MRIs should be considered after several years of CA.
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Rime H, Nguyen T, Ombredane K, Fostier A, Bobe J. Effects of the anti-androgen cyproterone acetate (CPA) on oocyte meiotic maturation in rainbow trout (Oncorhynchus mykiss). Aquat Toxicol 2015; 164:34-42. [PMID: 25911576 DOI: 10.1016/j.aquatox.2015.04.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/12/2015] [Accepted: 04/08/2015] [Indexed: 06/04/2023]
Abstract
In the present study, we aimed at characterizing the effect of cyproterone acetate (CPA), an anti-androgenic compound, on oocyte meiotic maturation in a freshwater teleost fish species, the rainbow trout (Oncorhynchus mykiss). Fully-grown post-vitellogenic ovarian follicles were incubated in vitro with CPA, luteinizing hormone (Lh) or a combination of CPA and Lh. Incubations were also performed using a combination of Lh and testosterone (T). The occurrence of oocyte maturation (i.e., resumption of the meiotic process) was assessed by monitoring germinal vesicle breakdown (GVBD) after a 72h in vitro incubation. The effect of CPA on the production of 17,20β-dihydroxy-4-pregnen-3-one (17,20βP), the natural maturation-inducing steroid (MIS), was quantified by radioimmunoassay. Our results show that CPA dramatically inhibits Lh-induced oocyte maturation and MIS synthesis. We also observed a synergistic effect of Lh and T on oocyte maturation in highly competent oocytes (i.e., able to resume meiosis after stimulation by low doses of Lh). Our results also show that a combination of CPA and Lh inhibits phosphorylation of extracellular signal-regulated kinase (Erk), kinases that are associated with oocyte maturation in many species. As a whole, our results indicate that CPA has a potential to alter meiotic maturation in rainbow trout. Further analyses are, however, needed to determine the mechanisms by which this anti-androgen interferes with the meiotic process. Furthermore, the present study provides a framework for better understanding of the ecological consequences of exposure to anti-androgens and resulting meiotic maturation abnormalities observed in trout.
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Affiliation(s)
- Hélène Rime
- INRA, UR1037 Fish Physiology and Genomics, Sex Differentiation and Oogenesis Group, F-35000 Rennes, France.
| | - Thaovi Nguyen
- INRA, UR1037 Fish Physiology and Genomics, Sex Differentiation and Oogenesis Group, F-35000 Rennes, France
| | - Kevin Ombredane
- INRA, UR1037 Fish Physiology and Genomics, Sex Differentiation and Oogenesis Group, F-35000 Rennes, France
| | - Alexis Fostier
- INRA, UR1037 Fish Physiology and Genomics, Sex Differentiation and Oogenesis Group, F-35000 Rennes, France
| | - Julien Bobe
- INRA, UR1037 Fish Physiology and Genomics, Sex Differentiation and Oogenesis Group, F-35000 Rennes, France
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Le Dare B, Jehannin A, Lanoe F, Philippe F, Tassel C, Abondo M, Marie N. [Treatment management of sexual offenders]. Ann Pharm Fr 2015; 73:257-65. [PMID: 25605258 DOI: 10.1016/j.pharma.2014.12.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 11/19/2022]
Abstract
In France, the Court can issue a medical treatment order only for criminally responsible persons. The nature of the treatment to be administered is at the discretion of the physician in charge of the sexual offender's care. Treatment management of sexual offenders relies essentially on psychotherapy, and preferentially cognitive behavioral therapy. For most severe sexual offenders, drug treatments, including hormonal treatment and selective serotonin reuptake inhibitors, are used to complement psychotherapy. This literature review aims at synthesizing practice changes in the treatment management of sexual offenders.
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Affiliation(s)
- B Le Dare
- Faculté de pharmacie, université de Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - A Jehannin
- Faculté de pharmacie, université de Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - F Lanoe
- Faculté de pharmacie, université de Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - F Philippe
- Faculté de pharmacie, université de Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - C Tassel
- Faculté de pharmacie, université de Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - M Abondo
- Service de médecine légale et médecine pénitentiaire, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - N Marie
- Service pharmacie, centre hospitalier Guillaume Régnier, 108, avenue du Général-Leclerc, 35703 Rennes cedex 7, France.
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Chung JPW, Yiu AKW, Chung TKH, Chan SSC. A randomized crossover study of medroxyprogesterone acetate and Diane-35 in adolescent girls with polycystic ovarian syndrome. J Pediatr Adolesc Gynecol 2014; 27:166-71. [PMID: 24656700 DOI: 10.1016/j.jpag.2013.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 07/20/2013] [Revised: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of 4-month treatment of medroxyprogesterone acetate (MPA) and Diane-35 on the clinical and biochemical features of hyperandrogenism and quality of life of adolescent girls with polycystic ovarian syndrome (PCOS). DESIGN A prospective, randomized, cross-over study. SETTING An accredited pediatric and adolescent gynecology clinic of a university-affiliated tertiary hospital. PARTICIPANTS 76 adolescents girls aged 14 to 19 years old with PCOS were recruited from July 2007 to July 2010. INTERVENTIONS Girls were randomized into 2 groups. Group 1 received oral MPA for 4 months, followed by a washout period of 4 months, and then Diane-35 for another 4 months. Group 2 received the same combination but in the reverse order. MAIN OUTCOME MEASURES Clinical and biochemical features of hyperandrogenism and quality of life were assessed. RESULTS There was no significant difference between the 2 groups at baseline. No significant difference was found in the clinical and biochemical parameters of hyperandrogenism before and after treatment with MPA. Significant reduction of the acne score, LH/FSH ratio, and testosterone level was seen after taking Diane-35. Hirsutism was also improved but it did not reach statistical significant. When comparing post-MPA and post-Diane-35, the post-Diane-35 group had significantly improved acne score and LH/FSH ratio. No significant difference was found on quality of life between both groups after treatment. CONCLUSION Diane-35 may be a more suitable treatment option in adolescent girls diagnosed with PCOS when compared to MPA.
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Affiliation(s)
- Jacqueline P W Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong.
| | - Alice K W Yiu
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Tony K H Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
| | - Symphorosa S C Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, New Territories, Hong Kong
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Abstract
The treatment of paraphilias remains a challenge in the mental health field. Combined pharmacologic and psychotherapeutic treatment is associated with better efficacy. The gold standard treatment of severe paraphilias in adult males is antiandrogen treatment with cognitive behavioral therapy. Selective serotonin reuptake inhibitors have been used in mild types of paraphilia and in cases of sexual compulsions and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe paraphilic subjects committing sexual offenses. In particular, gonadotropin-releasing hormone analogs have shown high efficacy working in a similar way to physical castration but being reversible at any time. Treatment recommendations, side effects, and contraindications are discussed.
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Affiliation(s)
- Alessandra Almeida Assumpção
- Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Frederico Duarte Garcia
- Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil; INSERM U1073, Rouen University Hospital, Rouen University, 22 Boulevard Gambetta, Rouen Cx 76183, France.
| | - Heloise Delavenne Garcia
- Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil; INSERM U1073, Rouen University Hospital, Rouen University, 22 Boulevard Gambetta, Rouen Cx 76183, France
| | - John M W Bradford
- Institute of Mental Health Research, Brockville Mental Health Centre, University of Ottawa, 1804 Highway 2 East, Brockville, Ontario K6V 5W7, Canada
| | - Florence Thibaut
- Psychiatry and Addictive Disorders, University Hospital Cochin-Tarnier, 89 rue d'Assas, 75006 Paris, France; Department of Psychiatry and Addictive Disorders, Faculté de Médecine Paris V Descartes, 75000 Paris, France; INSERM U894, Centre des Neurosciences, 2 ter rue d'Alesia, 75000 Paris, France
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Abstract
Cyproterone acetate (CPA) is a steroidal synthetic progestagen and anti-androgenic compound widely administered in prostate cancer which has been evidentially correlated with a severe hepatotoxic potency. Three male patients aged 78-83 years are presented, in whom severe hepatotoxic reactions emerged after CPA administration. Patients were treated with CPA at the doses of 200-300 mg/d for malignant prostate disease for 3-12 mo prior to the acute manifestation of the hepatic disease. Clinical features compatible with mixed hepatocellular and cholestatic liver disease including jaundice, white stools and dark urine, manifested in all three cases whereas encephalopathy and ascites were present in two of the patients. Other primary causes of hepatotoxicity (alcohol consumption and viral hepatitis) were also verified in two cases, and in those patients biopsy findings revealed the presence of cirrhotic lesions in liver parenchyma. Discontinuation of the therapeutic agent led to the amelioration of the clinical profile in all the patients whereas a patient died 40 d after hospital admission due to sepsis, despite acute liver disease improvement. The current article highlights the hepatotoxic potency of a widely administered therapeutic agent and illustrates the importance of clinical surveillance especially in patients with previous hepatic diseases. Three relevant cases are reported and a review of the published literature is made.
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Affiliation(s)
- Ioanna Savidou
- 2nd Department of Medicine, University of Athens Medical School, Hippokration General Hospital, 28 Achaias st, 11523 Athens, Greece
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Abstract
A 63-year-old man presented with acute urinary retention due to a retrovesical cystic tumor. Investigation revealed mucinous prostatic adenocarcinoma with metastatic involvement of testis and epididymis. He was treated with retrovesical tube drainage, bilateral orchiectomy and epididymectomy and cyproterone acetate.
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Affiliation(s)
- J Krogh
- a Departments of of Surgery A , Roskilde Hospital , Denmark
| | - P Georg Lund
- a Departments of of Surgery A , Roskilde Hospital , Denmark
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