RESUMEN
Following a European review, products containing the ethinylestradiol + cyproterone combination are back on the French market for women with acne (as second-line treatment) or hirsutism. Yet experience has shown that frequent off-label prescription of this combination for contraceptive purposes exposes many women to an unjustified risk of thromboembolism.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Ciproterona/efectos adversos , Etinilestradiol/efectos adversos , Hirsutismo/tratamiento farmacológico , Uso Fuera de lo Indicado , Ciproterona/administración & dosificación , Etinilestradiol/administración & dosificación , Humanos , Tromboembolia/inducido químicamenteRESUMEN
The aim of the present study was to evaluate the effects of commonly used treatment regimens such as metformin (MET) or an oral contraceptive pill (OC) containing ethynyloestradiol and cyproterone acetate (EE-CPA) on surrogate serum CVD risk factors and markers of endothelial dysfunction (CRP, IL-6, sVCAM) in women with PCOS.This study was conducted in a crossover design in order to compare the effects of 2 different treatment regimens in the same subject and has been registered under the number NCT01798875 in the ClinicalTrials.gov registry.42 women with PCOS (age range 18-36 years, median BMI 24.9) were randomly assigned to treatment with MET (850 mg bid) or EE-CPA containing OC for 4 months. After 2 months washout period, treatments were crossed over.Treatment with and OC increased significantly serum CRP concentrations (from 0.77 mg/l [95% CI: 0.70; 2.18] to 1.70 mg/l [95% CI: 1.65; 3.69], P<0.001). Treatment with MET slightly reduced serum CRP levels, but this difference did not reach statistical significance (P=0.08). 4 months treatment with MET or EE-CPA had no effect on serum IL-6 and sVCAM-1 concentrations (P>0.05).Treatment with EE-CPA containing OC for 4 months in women with PCOS significantly raises serum CRP. Since this rise was not accompanied by the increase in serum concentrations of IL-6, which is the most potent and effective stimulant of hepatic CRP production, we can speculate that this effect is caused by the liver first-pass effect of oral oestrogen administration. If this in turn can confer, cardiovascular risk among these women warrants further -studies.
Asunto(s)
Antagonistas de Andrógenos/administración & dosificación , Proteína C-Reactiva/metabolismo , Anticonceptivos Orales/administración & dosificación , Ciproterona/administración & dosificación , Hipoglucemiantes/administración & dosificación , Interleucina-6/sangre , Metformina/administración & dosificación , Síndrome del Ovario Poliquístico , Molécula 1 de Adhesión Celular Vascular/sangre , Adolescente , Adulto , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Factores de TiempoRESUMEN
PURPOSE: We aimed to evaluate the alteration of cardiovascular and metabolic risk parameters of polycystic ovary syndrome (PCOS) patients after a 6-month treatment with an oral contraceptive (OC) containing cyproterone acetate (CPA). METHODS: Forty women with PCOS were evaluated at baseline and after treatment with an OC. Carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), nitrate-mediated dilatation (NMD), high sensitive (hs)-CRP, lipid levels, index of glucose sensitivity, and homeostasis model assessment of insulin resistance index (HOMA) were assessed. RESULTS: Mean CIMT was significantly elevated (0.03 ± 0.01 mm) (p < 0.05). There was a tendency of reduction in FMD, which was significant among overweight patients (p < 0.05). Total cholesterol, low-density lipid (LDL), and triglyceride levels were significantly elevated (p < 0.05). CONCLUSION: CIMT as an indicator of early atherosclerosis and FMD as a finding of endothelial dysfunction seem to be deteriorated especially in overweight PCOS patients who were prescribed to OC containing cyproterone acetate for 6 months.
Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Anticonceptivos Orales Combinados/administración & dosificación , Ciproterona/administración & dosificación , Etinilestradiol/administración & dosificación , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Velocidad del Flujo Sanguíneo , Glucemia , Arteria Braquial , Enfermedades Cardiovasculares/fisiopatología , Grosor Intima-Media Carotídeo , Colesterol/sangre , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Anticonceptivos Orales Combinados/efectos adversos , Ciproterona/efectos adversos , Etinilestradiol/efectos adversos , Femenino , Humanos , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/fisiopatología , Factores de Riesgo , Testosterona/sangre , Triglicéridos/sangre , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effects of a pill with drospirenone (3 mg) plus ethinyl E(2) (20 µg) (DRP/20EE) alone or associated with metformin or cyproterone acetate (CPA) on some metabolic cardiovascular risk factors in women with polycystic ovary syndrome (PCOS). DESIGN: Randomized, open-label clinical trial. SETTING: Academic medical clinic. PATIENT(S): Forty-eight hirsute women with PCOS. INTERVENTION(S): Patients were randomized to treatment with DRP/20EE or with DRP/20EE plus metformin (1,500 mg/d) or with DRP/20EE plus CPA (12.5 mg/d, 10 days per cycle) for 6 months. MAIN OUTCOME MEASURE(S): Blood pressure, lipid profile, and indexes of glucose tolerance and insulin sensitivity were assessed before and after 6 months of treatment. RESULT(S): Body mass index and blood pressure were not modified by any treatment. Treatment with DRP/EE20 did not change the lipid profile; DRP/EE20 plus metformin significantly increased high-density lipoprotein cholesterol concentrations; DRP/EE20 plus CPA significantly increased triglycerides and total cholesterol. The area under the curve for insulin was significantly decreased by DRP/EE20 and DRP/EE20 plus metformin, but it was significantly increased by DRP/EE20 plus CPA. Treatment with DRP/EE20 plus CPA significantly increased the homeostasis model assessment of insulin resistance index and significantly reduced the glucose to insulin ratio index. Treatment with DRP/EE20 significantly increased the glucose to insulin ratio index. CONCLUSION(S): Treatment with DRP/EE20 improved insulin sensitivity in hirsute women with PCOS, with no deterioration of lipid profile. This effect was not ameliorated by the addition of metformin. The positive metabolic effects of DRP are abolished by the concomitant use of CPA.
Asunto(s)
Androstenos/efectos adversos , Enfermedades Cardiovasculares/epidemiología , Ciproterona/efectos adversos , Etinilestradiol/efectos adversos , Metformina/efectos adversos , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Administración Oral , Adolescente , Adulto , Andrógenos/sangre , Androstenos/administración & dosificación , Androstenos/uso terapéutico , Presión Sanguínea/fisiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/fisiopatología , Ciproterona/administración & dosificación , Ciproterona/uso terapéutico , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Estrógenos/administración & dosificación , Estrógenos/efectos adversos , Estrógenos/uso terapéutico , Etinilestradiol/administración & dosificación , Etinilestradiol/uso terapéutico , Femenino , Glucosa/metabolismo , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina/sangre , Lípidos/sangre , Metformina/administración & dosificación , Metformina/uso terapéutico , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/complicaciones , Factores de Riesgo , Adulto JovenRESUMEN
Prostate carcinoma is one of the most frecuent cancers in men. Significant numbers of patients have regional lymph node and bone metastases during the course of the disease. Mediastinal lymphadenopathy and cutaneous metastases are uncommon and signify well-advanced disease. We report the case of a patient with prostate cancer who develops mediastinal lymphadenopathy, pulmonary nodules and cutaneous metastases 8 years after the diagnosis.
Asunto(s)
Adenocarcinoma/secundario , Andrógenos , Metástasis Linfática , Mediastino/patología , Neoplasias Hormono-Dependientes/secundario , Neoplasias de la Próstata/patología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/tratamiento farmacológico , Antagonistas de Andrógenos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Ciproterona/administración & dosificación , Difosfonatos/uso terapéutico , Estramustina/administración & dosificación , Resultado Fatal , Flutamida/administración & dosificación , Humanos , Imidazoles/uso terapéutico , Cetoconazol/administración & dosificación , Neoplasias Pulmonares/secundario , Masculino , Neoplasias Hormono-Dependientes/diagnóstico por imagen , Neoplasias Hormono-Dependientes/tratamiento farmacológico , Neoplasias de la Próstata/tratamiento farmacológico , Cintigrafía , Neoplasias Cutáneas/secundario , Pamoato de Triptorelina/administración & dosificación , Ácido ZoledrónicoRESUMEN
OBJECTIVE: To report the case of an infertile female patient with cystic fibrosis who was diagnosed with endocervical metaplasia of the endometrium at diagnostic hysteroscopy and successfully treated with an oral estroprogestinic formulation. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old infertile female patient with cystic fibrosis. INTERVENTION(S): Hysteroscopy with multiple random biopsies was performed at the time of the first visit and after a 10-month cycle with an oral estroprogestinic formulation. MAIN OUTCOME MEASURE(S): Hysteroscopic evaluation with target biopsy; histological examinations of endometrial specimens. RESULT(S): Our patient benefited from a 10-month cycle with an oral estroprogestinic formulation. At the control visit we noticed a significant improvement in the hysteroscopic appearance of her endometrium, and the histological examination confirmed the complete reversion of the metaplastic alterations previously observed. CONCLUSION(S): The present report suggests a novel histological alteration possibly involved in affecting fertility in women with cystic fibrosis. In addition, the positive response to the estroprogestinic treatment observed in our patient poses new questions regarding the relationship between ovarian hormones and cystic fibrosis transmembrane conductance regulator protein regulation, offering interesting perspectives for a hormonal therapy in the treatment of subfertility in women with cystic fibrosis.
Asunto(s)
Cuello del Útero/patología , Fibrosis Quística/complicaciones , Fibrosis Quística/patología , Endometrio/patología , Infertilidad Femenina/etiología , Administración Oral , Adulto , Antagonistas de Andrógenos/administración & dosificación , Antagonistas de Andrógenos/uso terapéutico , Cuello del Útero/efectos de los fármacos , Ciproterona/administración & dosificación , Ciproterona/uso terapéutico , Combinación de Medicamentos , Endometrio/efectos de los fármacos , Estrógenos/administración & dosificación , Estrógenos/uso terapéutico , Etinilestradiol/administración & dosificación , Etinilestradiol/uso terapéutico , Femenino , Humanos , Histeroscopía , Trastornos de la Menstruación/complicaciones , Trastornos de la Menstruación/tratamiento farmacológico , Metaplasia , Resultado del TratamientoRESUMEN
UNLABELLED: During the menopause, levels of SHBG, IGF-I and IGFBPs are significantly modified by the use of different HRT regimens. OBJECTIVE: The aim of this study is to evaluate the influence of three different HRT regimens on serum levels of SHBG, IGF-I, IGFBP-1 and IGFBP-3 in postmenopausal women. METHODS: 41 postmenopausal women requesting HRT were enrolled in the study. Subjects were divided in three groups according to the therapy assigned; Group A: estradiol 2 mg/day+cyproterone acetate 1 mg/day in a cyclic sequential regimen; Group B: estradiol hemihydrate 2 mg/day plus norethisterone acetate (NETA) 1 mg/day in a continuous combined regimen; Group C: estradiol hemihydrate 1 mg/day plus NETA 0.5 mg/day in a continuous combined regimen. Blood samples were drawn before the start of hormonal treatment and after 6 months of HRT. Levels of SHBG, IGF-I, IGFBP-1 and IGFBP-3 in the serum were measured by means of a specific immunoassay. RESULTS: In group A, a significant increase of SHBG, no change of IGFBPs and a significant decrease of IGF-I were observed; in group B and in group C, no significant variations for any of the parameters were recorded. CONCLUSIONS: The association of cyproterone acetate to oral estradiol determines a significant reduction of IGF-I levels and an increase of SHBG; nevertheless, it does not seem to influence the serum levels of the IGF-I binding proteins. The treatment with oral continuous combined estrogens plus androgenic progestins, at low doses, produces minor, not significant, changes in the circulating levels of IGF-I, SHBG and IGFBPs.
Asunto(s)
Proteínas Sanguíneas/efectos de los fármacos , Terapia de Reemplazo de Estrógeno , Noretindrona/análogos & derivados , Adulto , Ciproterona/administración & dosificación , Esquema de Medicación , Estradiol/administración & dosificación , Femenino , Humanos , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 1 de Unión a Factor de Crecimiento Similar a la Insulina/efectos de los fármacos , Proteína 2 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Proteína 2 de Unión a Factor de Crecimiento Similar a la Insulina/efectos de los fármacos , Factor I del Crecimiento Similar a la Insulina/efectos de los fármacos , Persona de Mediana Edad , Noretindrona/administración & dosificación , Acetato de Noretindrona , Posmenopausia , Globulina de Unión a Hormona Sexual/efectos de los fármacosRESUMEN
A new oral contraceptive has been developed that contains a unique progestogen, drospirenone (DRSP), and that has both antiandrogenic and antimineralocorticoid activity. Our objective was to compare the effect of 30 microg ethinyl estradiol (EE)/3 mg DRSP (EE/DRSP; Yasmin, Schering AG, Berlin, Germany) with that of 35 microg EE/2 mg cyproterone acetate (EE/CPA; Diane-35, Schering AG, Berlin, Germany) on mild-to-moderate cases of acne. Diane-35 is used worldwide (it is not on the market in the United States and Japan) as a hormone treatment for acne, with additional contraceptive benefits. This multicenter, double-blind, randomized study was completed over 9 treatment cycles. A total of 128 women with mild-to-moderate facial acne, with or without seborrhea and/or hirsutism, were randomized. Treatment with either EE/DRSP or EE/CPA was assigned in a 2:1 ratio. Acne lesions, sebum production, and hair growth on the upper lip, chin, and chest were assessed, as well as levels of total and free testosterone, androstenedione, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH). At study completion, dermatologists, gynecologists, and subjects gave their overall assessment of the effect of treatment on acne. After 9 treatment cycles, the median total acne lesion count was reduced markedly by 62.5% in the EE/DRSP group and 58.8% in the EE/CPA group. A comparison of the 2 groups revealed that EE/DRSP was at least as effective as EE/CPA. Both preparations also reduced sebum production and hair growth on the upper lip and chin. A 3-fold increase in the levels of SHBG was observed in both treatment groups, and levels of androgens and LH decreased. Treatment differences were not seen. Subjective evaluation of the effect of treatment on facial acne by dermatologists, gynecologists, and the subjects themselves indicated an excellent or good improvement for most subjects in both groups. EE/DRSP has been shown to be as effective for treating mild-to-moderate acne as a preparation containing EE/CPA. This new preparation may provide useful hormone therapy for women with androgen-dependent disorders who also require contraception.
Asunto(s)
Acné Vulgar/tratamiento farmacológico , Androstenos/administración & dosificación , Anticonceptivos Orales Combinados/uso terapéutico , Ciproterona/administración & dosificación , Dermatitis Seborreica/tratamiento farmacológico , Dermatosis Facial/tratamiento farmacológico , Acné Vulgar/patología , Adolescente , Adulto , Antagonistas de Andrógenos/administración & dosificación , Dermatitis Seborreica/patología , Método Doble Ciego , Esquema de Medicación , Evaluación Preclínica de Medicamentos , Etinilestradiol/administración & dosificación , Dermatosis Facial/patología , Femenino , Alemania , Humanos , Países Bajos , Congéneres de la Progesterona/administración & dosificación , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.
Asunto(s)
Dismenorrea/diagnóstico , Endometrio , Imagen por Resonancia Magnética , Ultrasonografía , Adulto , Ciproterona/administración & dosificación , Ciproterona/efectos adversos , Diagnóstico Diferencial , Dismenorrea/inducido químicamente , Dismenorrea/patología , Endometrio/efectos de los fármacos , Endometrio/patología , Femenino , Humanos , Hipertricosis/tratamiento farmacológico , Metrorragia/diagnóstico , Metrorragia/patologíaRESUMEN
We report an unusual case of pulmonary lymphangioleiomyomatosis in a menopaused woman who had been taking estrogen hormone replacement therapy for several years. The characteristic feature of this uncommon disease is a proliferation of non-tumoral abnormal smooth muscle cells within the alveolar walls, and around the bronchi, lymph nodes and blood vessels. About twenty cases of pulmonary lymphangioleiomyomatosis have been described in menopaused women, who generally were taking estrogen hormone replacement therapy. This subpopulation does not appear to present any particular clinical, functional or radiographic features.
Asunto(s)
Neoplasias Pulmonares , Linfangioleiomiomatosis , Megestrol , Antagonistas de Andrógenos/administración & dosificación , Biopsia , Quilotórax/etiología , Ciproterona/administración & dosificación , Estradiol/administración & dosificación , Terapia de Reemplazo de Estrógeno , Femenino , Estudios de Seguimiento , Humanos , Pulmón/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Linfangioleiomiomatosis/diagnóstico por imagen , Linfangioleiomiomatosis/patología , Menopausia , Persona de Mediana Edad , Norpregnadienos/administración & dosificación , Congéneres de la Progesterona/administración & dosificación , Radiografía Torácica , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
The effects of 6 months of combined hormone therapy with transdermal estradiol (0.05 mg/day x 21 days) and different oral progestogens (10 mg/day medroxyprogesterone acetate [MPA] in the last 12 days, 10 mg/day dihydrogesterone in the last 12 days, and 50 mg/day cyproterone in the first 10 days), on menopausal symptoms and hypothalamo pituitary-ovarian function were studied in normal perimenopausal women. The study included 38 perimenopausal women, aged 43-49 years, with regular cycles of 26-32 days in length and menopausal symptoms. Endocrine status was determined by assay of basal levels of gonadotropins (LH, FSH), E2, and P every week until menstrual bleeding, before and during the first month of therapy. Plasma levels of LH and FSH were suppressed in the first month of therapy while E2 had a mean value of 45 +/- 12 pg/ml. Ultrasound examination and low levels of P indicated a complete block of ovulation and hypothalamo-pituitary-ovarian activity. All women reported the disappearance of vasomotor symptoms and nocturnal sweating. Transdermal estradiol and oral progestogens were well tolerated. This study shows that combined hormone therapy with low doses of transdermal estrogen patches and different oral progestogens reduces menopausal symptoms and also safeguards against unwanted pregnancies in the perimenopausal period.
Asunto(s)
Anticoncepción , Estradiol/administración & dosificación , Menopausia , Progestinas/administración & dosificación , Administración Cutánea , Adulto , Climaterio , Ciproterona/administración & dosificación , Estradiol/sangre , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hormona Luteinizante/sangre , Acetato de Medroxiprogesterona/administración & dosificación , Persona de Mediana Edad , Norprogesteronas/administración & dosificación , Progesterona/sangreRESUMEN
This study was designed to determine the benefit of therapy on final height (FHt) in girls with central precocious puberty (CPP). A total of 102 patients were evaluated--28 untreated, 26 treated with cyproterone acetate (CyA), and 48 treated with GnRH analogue (GnRHA)-and their achieved FHt was compared to the respective target height (THt). Of the untreated girls, half (14/28) had a slow course of puberty and reached THt +/- 0.5 SD (FHt 160.2 +/- 7.1, THt 159.5 +/- 6.6 cm); the other half (14/28) had an accelerated course of puberty with a FHt well below THt (FHt 150.8 +/- 4.3, THt, 159.2 +/- 5.9 cm) and in most cases (14/28) below the height-SDS of both parents. The treated girls (both regimens) reached THt above (CyA group: FHt 157.8 +/- 5.1, THt 156.8 +/- 5.1 cm; GnRHA group: 159.6 +/- 6.3, THt 157.7 +/- 5.7 cm). We conclude that without treatment the FHt of girls with CPP may be significantly compromised and that therapy is more beneficial if started before bone age exceeds 12 years. Our data also showed that for final height predictions in CPP the Bayley and Pinneau tables for average children should be used, regardless of the advanced bone age of the patients.
Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Estatura/efectos de los fármacos , Ciproterona/uso terapéutico , Luteolíticos/uso terapéutico , Pubertad Precoz/tratamiento farmacológico , Pamoato de Triptorelina/uso terapéutico , Administración Oral , Adolescente , Antagonistas de Andrógenos/administración & dosificación , Estatura/fisiología , Niño , Preescolar , Ciproterona/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intramusculares , Inyecciones Subcutáneas , Luteolíticos/administración & dosificación , Pubertad Precoz/fisiopatología , Resultado del Tratamiento , Pamoato de Triptorelina/administración & dosificaciónRESUMEN
OBJECTIVE: New regimens and routes of administration of hormonal replacement therapy (HRT) in climateric women are becoming available. Since there is no information on the neuroendocrine effects of sequential combined treatment with 17 beta-estradiol and a progestin, the present study evaluated the neuroendocrine, clinical vasomotor and psychological changes before and after different sequential combined HRT regimens (17 beta-estradiol plus nomegestrol acetate, or cyproterone acetate, or vaginal progesterone). Vasomotor and behavioral effects were evaluated by using the Kupperman score, while changes in plasma endorphin (beta-END) levels were used as marker of neuroendocrine effects. METHODS: Postmenopausal women (n = 30) were randomly divided into three groups (ten women for each group); all women received continuous 17 beta-estradiol (50 mg, transdermal) and each group was sequentially treated with different progestins for 12 days/month: group A, cyproterone acetate (5 mg p.o.); group B, nomegestrol acetate (5 mg p.o.); and group C, progesterone (100 mg, vaginal cream). A group of healthy fertile women (n = 8) served as control. Before and after 6 months of HRT, postmenopausal women underwent an evaluation of subjective Kupperman score and two neuroendocrine tests: (a) naloxone (4 mg i.v.) and (b) clonidine (1.25 mg i.v.). Plasma beta-END levels were measured before and at 15, 30, 45, 60 and 90 min after drug injection. Control women were studied by administering the two neuroendocrine tests only once. RESULTS: Postmenopausal women before HRT showed a pathological Kupperman and no changes of plasma beta-END levels in response to the clonidine and naloxone tests score. On the contrary the increase was significant in healthy women. In each of the three groups of treated women both naloxone and clonidine tests induced a significant increase in plasma beta-END levels (P < 0.01). After 6 months of HRT, an improvement of vasomotor and psychological symptoms was shown by a decrease of Kupperman score. CONCLUSIONS: The present study indicates that sequential treatment with transdermal 17 beta-estradiol and progestin, no matter which progestin was used, restores the beta-END release, improves vasomotor and psychological symptoms.
Asunto(s)
Terapia de Reemplazo de Estrógeno/métodos , Sistemas Neurosecretores/efectos de los fármacos , Posmenopausia/efectos de los fármacos , betaendorfina/efectos de los fármacos , Administración Cutánea , Administración Oral , Antagonistas de Andrógenos/administración & dosificación , Antagonistas de Andrógenos/uso terapéutico , Clonidina/farmacología , Estudios de Cohortes , Ciproterona/administración & dosificación , Ciproterona/uso terapéutico , Estradiol/administración & dosificación , Estradiol/uso terapéutico , Terapia de Reemplazo de Estrógeno/efectos adversos , Femenino , Humanos , Megestrol/administración & dosificación , Megestrol/análogos & derivados , Megestrol/uso terapéutico , Persona de Mediana Edad , Naloxona/farmacología , Antagonistas de Narcóticos/farmacología , Sistemas Neurosecretores/fisiología , Posmenopausia/sangre , Progesterona/administración & dosificación , Progesterona/uso terapéutico , Congéneres de la Progesterona/administración & dosificación , Congéneres de la Progesterona/uso terapéutico , Simpaticolíticos/farmacología , Cremas, Espumas y Geles Vaginales , Sistema Vasomotor/efectos de los fármacos , Sistema Vasomotor/fisiología , betaendorfina/sangre , betaendorfina/metabolismoRESUMEN
Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 +/- 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated.
Asunto(s)
Antagonistas de Andrógenos/uso terapéutico , Anticonceptivos Orales Combinados/uso terapéutico , Ciproterona/uso terapéutico , Hirsutismo/tratamiento farmacológico , Cetoconazol/uso terapéutico , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Espironolactona/uso terapéutico , Adolescente , Adulto , Antagonistas de Andrógenos/administración & dosificación , HDL-Colesterol/sangre , HDL-Colesterol/efectos de los fármacos , LDL-Colesterol/sangre , LDL-Colesterol/efectos de los fármacos , Estudios de Cohortes , Ciproterona/administración & dosificación , Deshidroepiandrosterona/sangre , Femenino , Hirsutismo/sangre , Hirsutismo/complicaciones , Hirsutismo/fisiopatología , Humanos , Cetoconazol/administración & dosificación , Hormona Luteinizante/sangre , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/fisiopatología , Espironolactona/administración & dosificación , Testosterona/sangreAsunto(s)
Antagonistas de Andrógenos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Imidazolidinas , Neoplasias de la Próstata/tratamiento farmacológico , Ciproterona/administración & dosificación , Flutamida/administración & dosificación , Humanos , Imidazoles/administración & dosificación , Masculino , Metaanálisis como AsuntoRESUMEN
En la anamnesis de la hirsuta, destaca el inicio peripuberal del hirsutismo y en el examen físico la importancia del vello pubiano que aporta el 40 por ciento del score total. Del 74 por ciento de hirsutas hiperandrogénicas, el 34 por ciento poseen elevación exclusiva de la testosterona, el 24 por ciento de la dehidroepiandrosterona sulfato y el 42 por ciento un alza de ambas. El alto porcentaje de dehidroepiandrosterona sulfato aumentada, sola o junto a testosterona, sugiere un compromiso suprarrenal en la etiología del hirsutismo, respaldado por un 50 por ciento de prueba de estimulación suprarrenal con hiperrespuesta de este andrógeno, en hirsutas y en pacientes con síndrome de ovario poliquístico. El alza de la 17 hidroxiprogesterona basal, obliga a realizar prueba de estimulación cob ACTH para descartar su origen ov+arico y confirmar el déficit de la 21 hidroxilasa. Un 5 por ciento de las hirsutas tenían acantosis nigricans con resistencia insulínica y alteraciones lipídicas. Se analiza el tratamiento con antiandrógenos, ciproterona y espironolactona y la frenación con glucocorticoides
Asunto(s)
Humanos , Femenino , Adolescente , Adulto , Enfermedades del Sistema Endocrino/complicaciones , Hirsutismo/etiología , 17-Cetosteroides/orina , Acantosis Nigricans/diagnóstico , Ciproterona/administración & dosificación , Etinilestradiol/administración & dosificación , Examen Físico/métodos , Hirsutismo/diagnóstico , Hirsutismo/tratamiento farmacológico , Hormonas/metabolismo , Hiperandrogenismo/diagnóstico , Resistencia a la Insulina , Testosterona/metabolismoRESUMEN
Cyproterone (cyproterone acetate) is a steroidal antiandrogenic agent that inhibits the action of adrenal and testicular androgens on prostatic cells. Additionally, its progestogenic activity causes a centrally mediated reduction in testicular secretion of androgens. Studies have demonstrated the effectiveness of cyproterone monotherapy in patients with prostate cancer, and for those in whom orchiectomy is not an acceptable option cyproterone may be a useful alternative. In addition, the drug may be administered in combination with surgical or gonadotrophin-releasing hormone (GnRH) agonist-mediated castration to ensure ablation of adrenal androgens. However, the effectiveness of cyproterone in combination with these forms of testicular androgen deprivation remains to be fully established. Trials to date have not demonstrated prolonged survival in patients receiving the combination therapy. Importantly, however, cyproterone does prevent acute exacerbation of disease during initial treatment with a GnRH agonist. Furthermore, combination therapy tends to be associated with a lower incidence of hot flushes than GnRH agonist-mediated or surgical castration alone. Thus, cyproterone 200 mg/day has proven efficacy in preventing acute flare of disease and reducing the incidence of hot flushes associated with GnRH agonist therapy or orchiectomy. It may also facilitate maximal androgen deprivation in patients receiving GnRH agonist therapy. If this drug is used as monotherapy, dosages of 250 mg/day or greater will probably be required.
Asunto(s)
Ciproterona , Ciproterona/administración & dosificación , Ciproterona/efectos adversos , Ciproterona/farmacocinética , Ciproterona/farmacología , Ciproterona/uso terapéutico , Humanos , Masculino , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/metabolismoRESUMEN
Experimental evidence and preliminary clinical data suggest a responsiveness of pancreatic adenocarcinoma to sex hormones and LH-RH agonists. In this study, we investigated the effect of the antiestrogen tamoxifen and the antiandrogen cyproterone acetate in combination with the LH-RH agonist buserelin in 9 patients with unresectable pancreatic adenocarcinoma. In all patients the disease was progressive under this therapeutic regimen. In conclusion, complete androgen blockade and antiestrogens in combination with LH-RH agonist cannot be recommended in patients with widespread pancreatic adenocarcinoma.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Pancreáticas/tratamiento farmacológico , Anciano , Buserelina/administración & dosificación , Ciproterona/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamoxifeno/administración & dosificación , Resultado del TratamientoRESUMEN
BACKGROUND: Male breast cancer (MBC) is considered an androgen-dependent tumor, and as in prostatic cancer, responses have been reported with use of antiandrogens or gonadotropin-releasing hormone analogs. Thus, it is reasonable to postulate that better results could be achieved by combining these two agents. METHODS: Eleven men with recurrent or progressive carcinoma of the breast have been treated with buserelin 1500 micrograms subcutaneously daily in the first week and 600 micrograms daily subsequently and cyproterone acetate (CPA) 100 mg twice a day orally starting 24 hours before the first dose of buserelin. RESULTS: Objective responses have been observed in seven patients with a median duration of 11.5 months (range, 9-24+ months). Responses were not correlated to the dominant site of disease. Three patients had stable disease lasting 5 months. Median survival was 18.5 months. Side effects primarily were decrease or loss of libido, impotence, and hot flushes. CONCLUSIONS: Total androgen blockade with buserelin and CPA seems effective in the treatment of patients with advanced cancer of the male breast, but its superiority over standard androgen suppression remains to be demonstrated.