RESUMEN
This study evaluated the use of the GnRH agonist hormone, deslorelin, to control the follicular population before initiating multiple ovulation and embryo transfer (MOET) treatment. Twenty-four cross-bred Santa Inês ewes, aged between 2 and 4 years, were randomly assigned to either a control group (n = 11) or a treated group (n = 13). All ewes received an intravaginal device containing 60 mg of medroxyprogesterone acetate on day 0, and a new device on day 7, which remained in place until day 14. Additionally, the ewes were administered 125 µg of cloprostenol on day 7. The superovulatory treatment involved administering 200 mg of pFSH, divided into eight decreasing doses at 12-h intervals starting on day 12. On day 14, 300 IU of eCG was administered. In the deslorelin group, three doses of 100 µg of deslorelin were administered starting on day 3 after the insertion of the vaginal device, with subsequent doses given at 72-h and 144-h intervals. Natural mating was performed 36 h after the removal of the progesterone implant using males with proven fertility. Embryo collection took place on the 6th day after mating, and the recovered structures were quantified and evaluated for quality and developmental stage. Transrectal ultrasonography was conducted on days 12, 16 and 21 to evaluate the ovaries, specifically to assess the ovarian follicular population and the presence of the corpus luteum. Ewes in the control group had higher embryo recovery rates (p < .01) compared to the treated group (5.2 ± 0.8 vs. 1.1 ± 0.8), with differences observed primarily in the number of morulae. The number of corpus luteum observed during the laparotomy on day 21 was significantly higher (p < .01) in the control group (10.44 vs. 4.5 corpus luteum per ewe). Yet, the treated group had a significantly higher number of follicles (p < .05) on the first day of pFSH application (5.5 vs. 3.0 follicles per ewe). In conclusion, although the inclusion of deslorelin in the superovulation protocol resulted in increased synchronization of oestrus and follicle number, it did not lead to an increase in the number of corpus luteum or harvested embryos.
Asunto(s)
Transferencia de Embrión , Hormona Folículo Estimulante , Superovulación , Pamoato de Triptorelina , Animales , Femenino , Pamoato de Triptorelina/análogos & derivados , Pamoato de Triptorelina/farmacología , Pamoato de Triptorelina/administración & dosificación , Superovulación/efectos de los fármacos , Hormona Folículo Estimulante/farmacología , Hormona Folículo Estimulante/administración & dosificación , Transferencia de Embrión/veterinaria , Cloprostenol/farmacología , Cloprostenol/administración & dosificación , Embarazo , Ovario/efectos de los fármacos , Folículo Ovárico/efectos de los fármacos , Oveja Doméstica , Ovinos/fisiología , Hormona Liberadora de Gonadotropina/farmacología , Hormona Liberadora de Gonadotropina/administración & dosificación , Acetato de Medroxiprogesterona/farmacología , Acetato de Medroxiprogesterona/administración & dosificaciónRESUMEN
CONTEXT: The role of body modifications induced by gonadal suppression in transgender and gender diverse adolescents on psychological functioning has not yet been evaluated. OBJECTIVE: The main aim of the present study was to explore several hormone, physical and psychological functioning changes during gonadotropin-releasing hormone analog (GnRHa) treatment in transgender and gender diverse adolescents (TGDAs). The potential relationship between the physical and hormone effects of GnRHa and psychological well-being, along with its magnitude, was assessed for the first time. METHODS: This prospective multidisciplinary study included 36 TGDA (22 assigned female at birth, and 14 assigned male at birth) who received psychological assessment followed by triptorelin prescription after referring to the Florence Gender Clinic. This study consisted of 3 time points: first referral (T0), psychological assessment (T1); and treatment with intramuscular injections of triptorelin for 3 up to 12 months (T2). Psychometric questionnaires were administered at each time point, and clinical and biochemical evaluations were performed at T1 and T2. RESULTS: The following results were found: (1) GnRHa showed efficacy in inhibiting puberty progression in TGDAs; (2) an increase in psychopathology was observed before starting GnRHa (T1) compared with baseline levels; (3) during GnRHa treatment (T2), a significant improvement in psychological functioning, as well as decrease in suicidality, body uneasiness, depression, and anxiety levels were observed; (4) hormone and physical changes (in terms of gonadotropin and sex steroid levels, height and body mass index percentiles, waist-hip ratio, and acne severity) observed during triptorelin treatment significantly correlated with a reduction in suicidal ideation, anxiety, and body image concerns. CONCLUSION: Psychological improvement in TGDA on GnRHa seems to be related to the objective body changes induced by a GnRHa. Therefore, the rationale for treatment with a GnRHa may not only be considered an extension of the evaluation phase, but also the start of a medical (even if reversible) gender-affirming path, especially in TGDAs whose puberty has already progressed.
Asunto(s)
Hormona Liberadora de Gonadotropina , Personas Transgénero , Adolescente , Femenino , Humanos , Masculino , Hormona Liberadora de Gonadotropina/análogos & derivados , Estudios Prospectivos , Pubertad/efectos de los fármacos , Pubertad/psicología , Pubertad/fisiología , Procedimientos de Reasignación de Sexo/métodos , Personas Transgénero/psicología , Transexualidad/tratamiento farmacológico , Transexualidad/psicología , Pamoato de Triptorelina/uso terapéutico , Pamoato de Triptorelina/administración & dosificaciónRESUMEN
A 9.4 mg deslorelin slow-release implant was inserted into an adult, healthy billy goat to achieve temporary infertility and a reduction in sexual behavior. The implant was inserted in late autumn. No significant change in testis size was observed over the following 6 weeks. The endocrine function of the testis, which was examined by stimulation with human chorionic gonadotropin, was also unchanged after 6 weeks compared to the initial examination. Histological examination revealed a preserved spermatogenesis.In conclusion, the application of a GnRH analogue implant in the adult male goat has no influence on the investigated parameters - and thus probably also on its fertility.
Asunto(s)
Implantes de Medicamentos , Cabras , Hormona Liberadora de Gonadotropina , Pamoato de Triptorelina , Animales , Masculino , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/análogos & derivados , Pamoato de Triptorelina/farmacología , Hormona Liberadora de Gonadotropina/administración & dosificación , Testículo/efectos de los fármacos , Preparaciones de Acción Retardada , Espermatogénesis/efectos de los fármacosRESUMEN
OBJECTIVES: Metastatic prostate cancer is the most common malignant cancer and the second leading cause of death due to various types of cancer among men after lung cancer. This study aimed to analyze the cost-effectiveness of triptorelin, goserelin, and leuprolide in the treatment of the patients with metastatic prostate cancer from the societal perspective in Iran in 2020. METHODS: This is a cost-effectiveness study in which a 20-year Markov transition modeling was applied. In this study, local cost and quality-of-life data of each health state were gathered from cohort of patients. The TreeAge pro 2020 and Microsoft Excel 2016 software were used to simulate cost-effectiveness of each treatment in the long term. The one-way and probabilistic sensitivity analyses were also performed to measure robustness of the model outputs. RESULTS: The findings indicated that the mean costs and utility gained over a 20-year horizon for goserelin, triptorelin, and leuprolide treatments were $ 13 539.13 and 6.365 quality-adjusted life-years (QALY), $ 18 124.75 and 6.658 QALY, and $ 26 006.92 and 6.856 QALY, respectively. Goserelin was considered as a superior treatment option, given the estimated incremental cost-effectiveness ratio. The one-way and probabilistic sensitivity analyses confirmed the robustness of the study outcomes. CONCLUSIONS: According to the results of the present study, goserelin was the most effective and cost-effective strategy versus 2 other options. It could be recommended to policy makers of the Iran healthcare system to prioritize it in clinical guidelines and reimbursement policies.
Asunto(s)
Antineoplásicos Hormonales , Goserelina , Leuprolida , Neoplasias de la Próstata , Años de Vida Ajustados por Calidad de Vida , Pamoato de Triptorelina , Anciano , Humanos , Masculino , Persona de Mediana Edad , Antineoplásicos Hormonales/uso terapéutico , Antineoplásicos Hormonales/economía , Análisis de Costo-Efectividad , Goserelina/uso terapéutico , Goserelina/economía , Goserelina/administración & dosificación , Irán , Leuprolida/uso terapéutico , Leuprolida/economía , Leuprolida/administración & dosificación , Cadenas de Markov , Metástasis de la Neoplasia , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/economía , Calidad de Vida , Pamoato de Triptorelina/uso terapéutico , Pamoato de Triptorelina/economía , Pamoato de Triptorelina/administración & dosificaciónRESUMEN
ABSTRACT Objective To determine whether first-voided urinary LH (FV-ULH) - level measurement can adequately assess pubertal suppression as much as standard tests can. Subjects and methods The study group included patients with central precocious puberty and rapidly progressing early puberty who received up to 3 - 4 doses of GnRHa therapy monthly and did not have adequate hormonal suppression after GnRH stimulation (90-minute LH level > 4 IU/L). Design: All of the participants underwent an LHRH test just after admission to the study. According to the stimulated peak LH levels, the patients were divided into 2 groups and followed until the end of the first year of treatment. The concordance between FV-ULH and stimulated LH levels was assessed. Results The FV-ULH levels in patients with inadequate hormonal suppression were significantly high compared to patients with adequate hormonal suppression. FV-ULH levels were very strongly correlated with stimulated LH levels (r = 0.91). Its correlation with basal LH levels was significant (r = 0.65). However, this positive correlation was modestly weakened after the first year of treatment. The cutoff value for FV-ULH of 1.01 mIU/mL had the highest sensitivity (92.3%) and specificity (100%). Conclusion FV-ULH levels, using more reliable and sensitive assay methods, can be used to monitor the adequacy of GnRHa therapy.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Pubertad Precoz/diagnóstico , Hormona Luteinizante/orina , Hormona Liberadora de Gonadotropina/administración & dosificación , Leuprolida/administración & dosificación , Pamoato de Triptorelina/administración & dosificación , Pubertad Precoz/orina , Pubertad Precoz/tratamiento farmacológico , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Resultado del TratamientoRESUMEN
PURPOSE: To present a rat model of subcutaneous endometriosis for the study of pathophysiology and the effects of drugs. METHODS: Fifty three-month-old female Wistar rats (Rattus norvergicus) were distributed into one control group and four treatment groups: estradiol (2.5; 5; 10mg/kg sc), medroxyprogesterone acetate (0.5; 2; 5mg/kg sc), triptorelin pamoate (0.18; 0.56mg/kg sc) and acetylsalicylic acid (3mg/kg per os). The animals were autoimplanted subcutaneously with 4x4-mm uterine fragments to induce endometriosis. The endometriomas were measured on days 1, 7, 14 and 21. The relative dry and wet weights of the endometrioma were used to evaluate response to the drug. Endometrial -like tissue was confirmed by histology. The greatest weight gain was observed on day 14 (relative wet weight: 29.1 ± 6.7mg%, relative dry weight: 5.3 ± 0.9mg %). Treatments were administered between day 5 and day 14. RESULTS: The relative wet weight of the hemiuterus in the 10mg/kg estradiol group differed significantly from control and the other two estradiol groups (p=0.0001). In the medroxyprogesterone acetate group the weight decreased significantly but this decrease was not dose-dependent. Weight reduction was also significant in the triptorelin pamoate and the acetylsalicylic acid groups. CONCLUSION: The model of subcutaneous endometriosis is reproducible, low-cost and easy to perform, and suitable for the study of pathophysiology and the effects of drugs. .
Asunto(s)
Animales , Femenino , Enfermedades del Tejido Conjuntivo/tratamiento farmacológico , Enfermedades del Tejido Conjuntivo/fisiopatología , Modelos Animales de Enfermedad , Endometriosis/tratamiento farmacológico , Endometriosis/fisiopatología , Tejido Subcutáneo , Antiinflamatorios no Esteroideos/administración & dosificación , Antineoplásicos Hormonales/administración & dosificación , Aspirina/administración & dosificación , Enfermedades del Tejido Conjuntivo/patología , Relación Dosis-Respuesta a Droga , Endometriosis/patología , Estradiol/administración & dosificación , Estrógenos/administración & dosificación , Acetato de Medroxiprogesterona/administración & dosificación , Ratas Wistar , Reproducibilidad de los Resultados , Factores de Tiempo , Pamoato de Triptorelina/administración & dosificaciónRESUMEN
Introducción: Existen diversas controversias respecto a las pruebas diagnósticas y tratamiento de la pubertad precoz central (PPC). El objetivo de este estudio es exponer las experiencias adquiridas en un grupo de niñas con PPC tratadas con triptorelina, analizándose las características auxológicas y pruebas diagnósticas. Materiales y métodos: Estudio observacional retrospectivo en un grupo de 60 niñas con PPC atendidas entre 2010 y 2017. Al diagnóstico se registraron datos sociodemográficos, auxológicos y hormonales, realizándose ecografía pélvica y resonancia craneal. Fueron tratadas con triptorelina, y tras su retirada fueron seguidas hasta la menarquia. Resultados: Al iniciar el tratamiento, la edad cronológica y edad ósea eran de 7,7±0,7 y 9,7±0,8 años, respectivamente (media±DE), con una velocidad de crecimiento de 8,3±1,6cm/año. La talla diana era de 161,1±5,8cm. El pico de LH tras estimulación era de 16,6±12,1 UI/l. El volumen ovárico era superior a 3 cc en el 35% de los casos. La resonancia magnética craneal fue patológica en 7 casos (11,7%). Al final del tratamiento, la edad cronológica y la edad ósea eran de 10,3±1,1 y 11,2±0,8 años, respectivamente, con una velocidad de crecimiento de 4,7±1,4cm/año. A la edad de la menarquia (11,9±0,9 años), la talla era de 157,5±5,7cm. Conclusiones: El tratamiento de la PPC con triptorelina parece resultar beneficioso. La posibilidad de bloquear el desarrollo puberal y ralentizar la maduración ósea permiten que las pacientes alcancen su talla diana. No obstante, sería preceptiva una monitorización auxológica personalizada
Introduction: There are several controversies regarding the diagnostic tests and management of central precocious puberty (CPP). The aim of this study is to present the experience acquired in a group of girls with CPP treated with triptorelin, and to analyze the auxological characteristics and diagnostic tests. Material and methods: An observational, retrospective study in a group of 60 girls with CPP was conducted between January 2010 and December 2017. Sociodemographic, auxological and hormonal data were recorded at diagnosis, and pelvic ultrasound and magnetic resonance imaging of the head were performed. Girls were treated with triptorelin and monitored after treatment discontinuation until menarche. Results: At treatment start, chronological age and bone age were 7.7±0.7 and 9.7±0.8 years respectively, and growth velocity was 8.3±1.6cm/year. Target height was 161.1±5.8cm. Peak LH level after stimulation was 16.6±12.1 IU/l. Ovarian volumes were greater than 3mL in 35% of cases. MRI of the head was pathological in seven girls (11.7%). At treatment completion, chronological age and bone age were 10.3±1.1 and 11.2±0.8 years respectively, and growth velocity was 4.7±1.4cm/year. At the age of menarche (11.9±0.9 years), height was 157.5±5.7cm. Conclusions: Treatment of CPP with triptorelin appears to be beneficial. The possibility to block pubertal development and slow skeletal maturation allows patients to reach their target height. However, individualized auxological monitoring would be mandatory
Asunto(s)
Humanos , Femenino , Niño , Pubertad Precoz/diagnóstico , Pubertad Precoz/tratamiento farmacológico , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/uso terapéutico , Pelvis/diagnóstico por imagen , Cráneo/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Menarquia/efectos de los fármacos , Estudios LongitudinalesRESUMEN
Objetivo: Valorar si existen diferencias en los resultados de los ciclos de FIV-ICSI en función del protocolo de estimulación empleado. Método: Estudio retrospectivo descriptivo de pacientes infértiles que fueron sometidas a ciclos de FIV-ICSI en el Hospital Universitario La Paz, entre los meses de enero y septiembre de 2010, comparando un protocolo largo de estimulación con análogos de GnRH vs un protocolo corto con antagonistas de GnRH. Las variables analizadas fueron: tasa de gestación, necesidad de cancelación del ciclo, dosis total de gonadotropinas requerida durante la estimulación, niveles de estradiol sérico el día de la administración de la hCG, número de folículos puncionados, complejos obtenidos, número de ovocitos maduros y de embriones conseguidos. Resultados: No hubo diferencias estadísticamente significativas en los resultados de los ciclos en función del protocolo de estimulación empleado, en ninguna de las variables analizadas. Conclusiones: Este estudio no encontró diferencias en los resultados de los ciclos de FIV-ICSI con relación al uso de análogos o antagonistas de GnRH. Es necesarios más estudios con mayores tamaños muestrales para definir qué tipo de pacientes serían subsidiarias de recibir cada tratamiento para conseguir resultados óptimos.
Aims: To assess if there exist any differences in the results of the IVF-ICSI cycles depending on the stimulation protocol employed. Methods: Retrospective descriptive study of infertile patients who underwent IVF-ICSI cycles at La Paz University Hospital, between January and September 2010, comparing sitmulation protocol with GnRH agonists vs antagonists of GnRH. The variables analyzed were pregnancy rate, cancellation rate, total dose of gonadotropin required for stimulation, serum estradiol levels on the day of hCG administration, number of follicles punctured, complexes obtained, number of mature oocytes and of embryos obtained. Results: No statistically significant differences where found in the results of cycles depending on the protocol of stimulation used in any of the variables analyzed. Conclusions: This study didn't find any difference in the outcome of IVF-ICSI cycles in relation to the use of GnRH agonists or antagonists. We need more studies with larger sample sizes to determine which is the best treatment to each patient in order to achieve optimal results.
Asunto(s)
Humanos , Adulto , Femenino , Embarazo , Fertilización In Vitro/métodos , Hormona Folículo Estimulante/administración & dosificación , Hormona Liberadora de Gonadotropina/análogos & derivados , Hormona Liberadora de Gonadotropina/antagonistas & inhibidores , Antagonistas de Hormonas/administración & dosificación , Protocolos Clínicos , Hormona Antimülleriana/análisis , Hormona Folículo Estimulante/análisis , Hormona Liberadora de Gonadotropina/agonistas , Infertilidad , Síndrome de Hiperestimulación Ovárica , Inducción de la Ovulación , Índice de Embarazo , Pamoato de Triptorelina/administración & dosificación , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJETIVO: Realizar un análisis comparativo de la eficacia y la seguridad de los análogos de la LHRH de administración semestral con indicación para el tratamiento del cáncer de próstata.MÉTODO - Búsqueda en la base de datos PubMed de los ensayos clínicos (clinicals trials) publicados en el período 2006-2009 con las siguientes palabras claves: prostate cancer y triptorelin o leuprorelin y 6 month depot.RESULTADOS Los 3 análogos de la LHRH de administración semestral autorizados en la actualidad tienen una elevada eficacia (96-98%) en la disminución de los niveles de testosterona por debajo de los 50 ng/dl. Debido a la heterogeneidad de los pacientes incluidos en los 3 ensayos y a la variabilidad en la forma de presentar los resultados, no es posible comparar los escapes de testosterona ni su eficacia sobre los niveles de PSA. Se comunicaron una elevada incidencia de acontecimientos adversos (AA) en los 3 estudios, aunque solo fueron graves entre el 0,9% y el 15,8%. Solo en un estudio se comunicó la retirada de pacientes (2,5%) por AA relacionados con el fármaco.CONCLUSIÓN - A pesar de que en los 3 estudios existe una importante variabilidad del análisis y la forma de expresar los datos, no parece que existan grandes diferencias en cuanto a eficacia y seguridad(AU)
OBJECTIVES: To perform comparative analysis of the efficacy and the safety of six months formulation of LHRH analogues indicated for prostate cancer treatment.METHOD: Search in the PubMed database for clinical trials published between 2006 and 2009 using the following key words: prostate cancer, triptorelin or leuprorelin and 6-month depot.RESULTS: The efficacy of all 3 six months formulation of LHRH analogues currently approved is high (96-98%) for reducing testosterone levels down to below 50 ng/dl. As the patients included in the three trials are quite heterogeneous, and due to the variability in the way of presenting results, it is not possible to compare testosterone escapes and their effect on PSA levels. The incidence of adverse events (AE) reported across the three trials was high, but only 0.9% to 15.8% were severe. Only one trial reported patient withdrawal (2.5%) because of drug-related AEs.CONCLUSION: Even though all the studies show and important variability in the analysis and data management, no significant efficacy and safety differences seem to exist(AU)
Asunto(s)
Humanos , Masculino , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/terapia , Hormona Liberadora de Gonadotropina/análogos & derivados , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/uso terapéutico , Eficacia/métodos , Seguridad/estadística & datos numéricos , Leuprolida/análogos & derivados , Leuprolida/administración & dosificación , Leuprolida/uso terapéutico , Pamoato de Triptorelina/análogos & derivados , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/uso terapéuticoRESUMEN
El síndrome de Youssef o menuria tras una fístula vesicouterina ha sido raramente publicado. Este caso difiere de los previamente comunicados en que el tratamiento mediante análogos de la GnRH hizo posible el cese de la menuria y, por tanto, un éxito del tratamiento conservador (AU)
Asunto(s)
Adulto , Embarazo , Femenino , Humanos , Fístula/diagnóstico , Enfermedades Uterinas/diagnóstico , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/uso terapéutico , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/diagnóstico , Cistoscopía/métodos , Hormona Liberadora de Gonadotropina/administración & dosificación , Hormona Liberadora de Gonadotropina/uso terapéutico , Fístula de la Vejiga Urinaria/diagnóstico , Ciprofloxacina/administración & dosificación , Ciprofloxacina/uso terapéutico , Incontinencia Urinaria/diagnóstico , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina/uso terapéutico , Fístula/prevención & control , FístulaRESUMEN
No disponible
Asunto(s)
Adulto , Femenino , Persona de Mediana Edad , Humanos , Pamoato de Triptorelina/administración & dosificación , Pamoato de Triptorelina , Anticonceptivos Orales/administración & dosificación , Anticonceptivos Orales , Biomarcadores de Tumor/análisis , Tumor de Células de Leydig/diagnóstico , Hiperplasia/complicaciones , Hiperplasia/cirugía , Hiperandrogenismo/diagnóstico , Neoplasias , Células del Estroma/patología , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/cirugía , Hirsutismo/complicaciones , Amenorrea/complicaciones , Hipercolesterolemia/diagnóstico , Antígeno Carcinoembrionario/análisis , Antígeno Carcinoembrionario , Testosterona/análisis , TestosteronaRESUMEN
Presentamos un caso de embarazo ectópico tras fecundación in vitro y transferencia intrauterina guiada por ecografía. El ascenso de la gonadotropina coriónica humana (HCG), asociado a la ecografía hizo sospechar la presencia del embarazo ectópico. La laparoscopia diagnóstica halló unas trompas normales y una tumoración ovárica izquierda de 3-4 cm compatible con un cuerpo lúteo hemorrágico o ectópico ovárico. El tratamiento conservador por laparoscopia del embarazo permitió conservar la funcionalidad de ese ovario. La transferencia de embriones ecoguiada no evita el embarazo ectópico a pesar de asegurarnos la correcta ubicación de los embriones, tal como muestra nuestro caso (AU)