Low-dose estradiol and endothelial and inflammatory biomarkers in menopausal overweight/obese women

OBJECTIVE

We aimed to investigate the effects of low-dose transdermal estrogen on endothelial and inflammatory biomarkers in menopausal overweight/obese women.

METHODS

We recruited 44 menopausal women (47-55 years; body mass index 27.5-34.9 kg/m(2)) and divided them into estradiol (1 mg/day; n = 22) or placebo groups (n = 22). They were double-blinded, followed and treated for 3 months. At baseline and post-intervention, inflammatory biomarkers (hs-CRP, IL-1β, IL-6, MCP-1 and TNF-α) and of vascular injury (activated circulating endothelial cells, CEC-a) and repair (endothelial progenitor cells, EPC) were quantified. Resting CECs (CEC-r) were also assessed. Microvascular reactivity and vasomotion were analyzed by laser-Doppler flowmetry.

RESULTS

Volunteers (51.8 ± 2.3 years; mean body mass index 31.5 ± 2.5 kg/m(2)) had been menopausal for 3 (range 2-5) years. After treatment, no changes were observed in the placebo group, while levels of CEC-r and EPC increased in the estradiol group. In this group, no changes in inflammatory biomarkers were observed but it required a lower cumulative dose of acetylcholine to achieve peak velocity during endothelial-dependent vasodilatation and there was increased endothelial-independent vasodilatation.

CONCLUSIONS

The short-term use of low-dose transdermal estradiol therapy in overweight/obese menopausal women increased markers of vascular repair and improved microvascular reactivity without changing the inflammatory biomarkers.

CLINICAL TRIAL REGISTRATION

NCT01295892 at www.clinicaltrials.gov .

Tireoidite supurativa aguda com múltiplas complicações

A tireoidite supurativa aguda é uma desordem rara, mais frequentemente causada pelo Staphylococcus aureus ou Streptococcus pneumoniae, e atinge particularmente crianças com fístula do seio piriforme. Em adultos, a disseminação por via hematogênica a partir de foco infeccioso em orofaringe ou trato respiratório parece ser o principal mecanismo patogênico. Os sinais e sintomas iniciais da tireoidite aguda são semelhantes aos da faringite aguda e da tireoidite subaguda. Esse fato frequentemente retarda o diagnóstico dessa doença e aumenta o risco de complicações. Relatamos o caso de um paciente masculino de 28 anos, previamente saudável, que, após quadro de amigdalite, apresentou tireoidite aguda complicada por tireotoxicose, volumoso abscesso no lobo direito da tireoide, que se estendia à abertura superior do tórax com desvio da traqueia e compressão de grandes vasos, associado à trombose de veia jugular interna e sepse.

Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study

BACKGROUND

There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease.

OBJECTIVE

We aimed to assess the effects of androgen replacement on cardiovascular risk factors.

DESIGN

Thirty-seven postmenopausal women aged 42-62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo.

METHODS

Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography.

RESULTS

A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance.

CONCLUSION

This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.