The association between prolactin, high-sensitivity C-reactive protein and Framingham risk score in menopause.

AIMS: To evaluate the association between serum prolactin, high-sensitivity C-reactive protein (hs-CRP) levels and cardiovascular disease risk in postmenopausal women regarding the Framingham Risk Score (FRS). METHODS: Fifty-eight menopausal women were enrolled into the cross-sectional study. All participants had 24-hour ambulatory blood pressure monitoring, echocardiography, electrocardiography, and carotid intima-media thickness measurement. Blood samples were obtained for prolactin, hs-CRP, lipid profile, fasting glucose, and insulin. RESULTS: Among the participants, 67.24% had a FRS <10%, and 32.75% had a FRS ≥10%. Levels of prolactin and hs-CRP did not differ between the FRS groups. In the FRS <10% group, significantly higher levels of prolactin were found. Cases with hypertension have significantly higher levels of hs-CRP. Prolactin and hs-CRP were found to be associated with hypertension in the FRS <10% and ≥10% groups, respectively. CONCLUSIONS: Hypertensive postmenopausal women with low risk for cardiovascular diseases have increased levels of prolactin, suggesting a possible role in the pathogenesis of hypertension. The correlation of hs-CRP with systolic blood pressure can be interpreted as a potential effect of hypertensive heart disease reflecting a state of high-risk milieu with elevated inflammatory markers.

Effects of transdermal and oral hormone replacement therapies on monocyte chemoattractant protein-1 levels: a randomized clinical trial.

OBJECTIVES: To assess the effects of oral and transdermal hormone replacement therapies (HRT) on levels of important cardiovascular disease (CVD) markers, MCP-1 and homocyteine, in the early postmenopausal period. STUDY DESIGN: Seventy-six healthy, early postmenopausal women were enrolled in the study. Patients were randomly assigned to receive oral or transdermal HRT for 6 months. The first group received continuous combined oral HRT containing 1mg 17ß-estradiol and 0.5mg norethisterone acetate (n=39), and the second group received sequential transdermal HRT releasing 50µg/day estradiol alone given twice a week on days 1-14 and 50µg/day estradiol plus 0.25mg/day norethisterone acetate given twice a week on days 15-28 (n=37). Circulating levels of MCP-1 and homocysteine, along with other CVD markers, were assessed before and after treatment in all patients. RESULTS: There were no significant differences between the baseline characteristics of the two groups. Baseline serum MCP-1 levels were similar between the oral and transdermal HRT groups (150.1±12.8 vs. 145.2±11.6pg/ml; P=.219). The mean MCP-1 levels did not change after 6 months of HRT in both oral (150.1±12.8 vs. 153.6±12.5pg/ml; P=.192) and transdermal HRT groups (145.2±11.6 vs. 146.1±15.1pg/ml; P=.419). Moreover, there was no significant difference between the groups in MCP-1 serum levels after 6 months of HRT. Similarly, no difference was found in serum homocyteine levels following 6 months of HRT. CONCLUSIONS: Both oral continuous and sequential transdermal HRTs do not have significant effects on serum MCP-1 and homocyteine levels in women during the early postmenopausal period.

Clinical diagnosis and complications of paratubal cysts: review of the literature and report of uncommon presentations.

INTRODUCTION: Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion. METHODS: Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed. RESULTS: Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem. CONCLUSION: Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.

Obesity and insulin resistance associated with lower plasma vitamin B12 in PCOS.

Polycystic ovary syndrome (PCOS) shares some or most components of metabolic cardiovascular syndrome, manifested by abdominal obesity, insulin resistance, dyslipidaemia and atherosclerosis. It has been previously demonstrated that folate and vitamin B(12) treatment improved insulin resistance in patients with metabolic syndrome. This study first investigated whether PCOS patients have lower or higher vitamin B(12), folate and homocysteine concentrations when compared with healthy, age and body mass index matched controls, and, then examined associations between vitamin B(12), folate, homocysteine and insulin resistance and obesity in PCOS patients. Homocysteine concentrations and homeostasis model assessment index were higher, whereas concentrations of vitamin B(12) were lower in PCOS patients with insulin resistance compared with those without insulin resistance. Serum vitamin B(12) concentrations were significantly lower in obese PCOS women in comparison with obese control women (P < 0.05). Fasting insulin, insulin resistance and homocysteine are independent determinants of serum vitamin B(12) concentrations in PCOS patients. Insulin resistance, obesity, and elevated homocysteine were associated with lower serum vitamin B(12) concentrations in PCOS patients.

Comparative effects of atorvastatin and simvastatin on the plasma total homocysteine levels in women with polycystic ovary syndrome: a prospective randomized study.

OBJECTIVE: To test the hypothesis that statins improve hyperhomocysteinemia in women with polycystic ovary syndrome (PCOS). DESIGN: A prospective randomized study. SETTING: University Hospital. PATIENT(S): Fifty-two women with PCOS and 52 women matched for age and body mass index as controls. INTERVENTION(S): Patients were randomly divided into two groups for treatment: group 1, atorvastatin, 20 mg daily (n = 26), and group 2, simvastatin, 20 mg daily (n = 26). Blood samples were obtained before and after treatment. MAIN OUTCOME MEASURE(S): Serum homocysteine levels. RESULT(S): After 12 weeks of treatment, serum homocysteine levels in group 1 had decreased from 14.3 +/- 2.9 to 10.6 +/- 1.7 micromol/L; in group 2, the levels decreased from 13.6 +/- 2.1 to 11.1 +/- 1.9 micromol/L. Both two groups, free testosterone and total testosterone declined statistically significantly (38.3% and 36.5%; and 40.6% and 46.0%, respectively). In group 1, vitamin B(12) increased from 362.1 +/- 107 to 478.7 +/- 267 pg/mL; in group 2, it increased from 391.3 +/- 107 to 466 +/- 211 pg/mL, but the change did not reach statistical significance. There was a considerable decline in the homeostatic model assessment index in group 1 (40.0% to 32.1%). CONCLUSION(S): Treatment with statins in women with PCOS leads to decreases in serum homocysteine levels.

Effect of hormone replacement therapy on serum levels of tumor markers in healthy postmenopausal women.

OBJECTIVE: The effect of hormone replacement therapy (HRT) on serum levels of tumor markers is barely defined. The aim of this study was to evaluate the effect of HRT on levels of tumor markers CA 125, CA 15-3, CA 19-9, CEA and alpha-FP. METHODS: Retrospective analysis of prospectively collected data in healthy postmenopausal women under oral estrogen replacement therapy (ERT, conjugated equine estrogen (CEE) 0.625 mg (n = 21) or estradiol 2 mg (n = 31)), and continuous combined estrogen and progesterone regimen (HRT, CEE 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n = 34) or estradiol 2 mg plus norethisterone acetate 1 mg (n = 37)). One hundred and twenty-three healthy women among a sampled population of 654 postmenopausal patients with complete records, initial normal tumor marker levels, and at least 1 year of follow-up were included into the study. Tumor markers were measured with 1-year interval. RESULTS: Fifty-two (41.5%) patients were under ERT and 71 (58.5%) were under combined HRT. The number of months since menopause, age and age at menopause did not influence tumor marker levels at first admission. All of the tumor marker levels were in normal range after 1 year. Pretreatment CA 125 II, CA 15-3 and CEA levels were significantly low (median and range) 5.0 (1.0-11.8) versus 7.45 (1.0-18.1) U/ml for CA 125, 27.05 (7.3-37.5) versus 32.6 (12.5-37.9) U/ml for CA 15-3, 0.88 (0.58-2.8) versus 1.34 (0.53-2.41) ng/ml for CEA in women with hysterectomy when compared to women without hysterectomy. There was no effect of ERT on CA 125 II, CA 19-9, CEA and alpha-FP levels. E2 led to a significant decrease in post-treatment CA 15-3 levels [32.9 (8.1-34.9) vs. 18.1 (6.7-31.4); P < 0.001]. CA 125 levels were only significantly reduced in hysterectomised women using continuously combined HRT [7.9 (2.6-17.7) vs. 5.6 (1.3-19.2) for CEE+MPA, and 7 (1-18.1) vs. 5.8 (1.8-17.4) for E2 + NETA; P < 0.05]. There was a small, but not significant, increase in CA 125 levels in women under ERT. CONCLUSION: Although there was a statistically significant decrease in CA 15-3 levels in current E2 and E2 + NETA users, and a decrease in CA 125 levels in combined regimens, this change is clinically not relevant in healthy postmenopausal women. This data will be useful for the caregivers in the management and follow-up of cancer survivors who preferred replacement therapy as the only treatment of their postmenopausal symptoms.

Serologic assay of Helicobacter pylori infection. Is it useful in hyperemesis gravidarum?

OBJECTIVE: To assess the association of Helicobacter pylori seropositivity with hyperemesis gravidarum. STUDY DESIGN: A prospective study was performed on 160 pregnant women who were admitted to an outpatient clinic for prenatal care from November 2000 to December 2001. Eighty patients with hyperemesis gravidarum and 80 asymptomatic, pregnant women were examined for serum anti-H pylori IgG antibodies. Serum anti-H pylori IgG antibodies were evaluated using a commercially available enzyme-linked immunosorbent assay (ELISA)-based kit. Statistical analysis was conducted by using the Student t, chi 2 and Mann-Whitney U test. A P value < .05 was considered significant. RESULTS: The overall prevalence of H pylori seropositivity was 65.6%. Fifty-six of 80 hyperemesis patients (70%) and 49 of 80 control subjects (61.2%) were positive for anti-H pylori IgG antibodies. No significant difference in H pylori seropositivity was found between the groups. CONCLUSION: H pylori seropositivity is not significantly associated with hyperemesis gravidarum. Since we could not absolutely demonstrate that seropositivity for H pylori is associated with hyperemesis gravidarum, routine serologic analysis for H pylori is not encouraged. Understanding the role of H pylori infection in the pathogenesis of hyperemesis gravidarum necessitates further studies.