Impaired CRH and urocortin expression and function in eutopic endometrium of women with endometriosis.

CONTEXT: Women with endometriosis have altered endometrial function. CRH and urocortin (Ucn) are neuropeptides produced by human endometrium and modulate endometrial decidualization. OBJECTIVE: To evaluate endometrial mRNA expression of CRH and Ucn, their role in in vitro decidualization of cultured human endometrial stromal cells (HESCs) in patients with endometriosis, and the role of CRH receptors (CHR-Rs). DESIGN: Obstetrics and Gynecology, University of Siena. PATIENTS: Endometrial specimens were obtained from patients with and without endometriosis. INTERVENTIONS: Endometrial biopsy obtained at both phases of menstrual cycle. In vitro decidualization of HESCs collected from endometriosis or control was done in the presence of CRH, Ucn, or CRH receptor type 1 (CRH-R1, antalarmin) or type 2 (CRH-R2, astressin 2b) antagonists. OUTCOME MEASURES: Endometrial mRNA expression of CRH and Ucn during endometrial cycle; prolactin, CRH-R1, and CRH-R2 mRNA expression during in vitro decidualization. RESULTS: In healthy women CRH and Ucn expression were significantly higher (P < 0.05) in secretory than in proliferative phase; no differences were observed in endometriotic women. During in vitro decidualization, prolactin mRNA expression and release in endometriosis was lower than in control (P < 0.001). CRH and Ucn were able to significantly increase (P < 0.01) prolactin release only in control group; moreover, in this group antalarmin reduced prolactin release (P < 0.01). CRH-R1 mRNA expression increased during in vitro decidualization of HESCs in control (P < 0.01) but not in endometriosis. CONCLUSIONS: Women with endometriosis show an impaired endometrial expression of CRH and Ucn mRNA, and these neuropeptides are no more active in modulating the in vitro decidualization of HESCs, associated with a reduced expression of CRH-R1 mRNA.

New protocol of clomiphene citrate treatment in women with hypothalamic amenorrhea.

OBJECTIVE: To determine if a new protocol of administration of clomiphene citrate (CC) is effective in menstrual cycle recovery in women with hypothalamic secondary amenorrhea. DESIGN: This was an open-label study. PATIENTS: Patients comprised a group of eight women with secondary amenorrhea. Interventions. An oral preparation containing CC (50 mg/day) was administered for 5 days followed by a double dose (100 mg/day) for another 5 days, initiated on day 3 after estrogen/progestogen-induced withdrawal bleeding. If ovulation and vaginal bleeding occurred, treatment continued in the two next months with 100 mg/day from day 3 to day 7 day of the cycle. MAIN OUTCOME MEASURES: Cycle control was evaluated at each visit, when patients recorded bleeding patterns and tablet intake. Data on the intensity and duration of bleeding were collected. RESULTS: Six patients responded to the first cycle of CC administration, resuming normal menstrual cycles. The other two patients failed to menstruate after the first 10 days of treatment with CC and repeated the same protocol. After the second administration, these two women also had normal menstrual bleeding. CONCLUSIONS: The present data show that this new protocol of CC treatment may be useful to restore normal menstrual cycles in young women with hypothalamic amenorrhea.

Vaginally administered estroprogestinic decreases serum inhibin A and inhibin B levels and reduces endometrial thickness.

OBJECTIVE: Serum levels of inhibin A, inhibin B, FSH, and LH were measured in healthy volunteers before and during oral or vaginal estroprogestinic administration. In addition, the effect on endometrial thickness and on follicular growth pattern were also assessed by vaginal ultrasound. DESIGN: Prospective study. SETTING: University of Siena. PATIENT(S): Seventeen healthy fertile women. INTERVENTION(S): This open-label study was performed in 10 healthy volunteers, who were assigned to vaginal ethinylestradiol (15 microg) and etonogestrel (120 microg), one ring to be used for one cycle, after stratification for the ovulation day in a pretreatment cycle. A similar study on seven women assigned to oral ethinylestradiol (20 microg) and levonorgestrel (100 microg) was considered, to compare the effects of the two different routes of administration. Blood samples were collected the cycle before (days 8-10) and during (days 8-10) vaginal ring insertion and serum inhibin B, inhibin A, FSH, and LH levels were measured by ELISA. Concomitantly, transvaginal ultrasound was performed in all subjects for endometrial and follicular growth assessment. MAIN OUTCOME MEASURE(S): Inhibin A, inhibin B, FSH, and LH levels. RESULT(S): Vaginal administration induced a significant decrease of serum inhibin A, inhibin B, FSH, and LH. No significant changes in inhibin B and FSH secretion were observed during oral contraceptive (OC) administration, whereas LH and inhibin A levels significantly decreased. Endometrial thickness and ovarian volume decreased significantly during vaginal ring insertion, but not after OC administration. CONCLUSION(S): The present findings showed that treatment with vaginal estroprogestinic decreases serum inhibin A and inhibin B levels, the follicular diameter, and endometrial thickness, showing a rapid and significant effect with the vaginal route.

Doença de Castleman na pelve feminina: Relato de caso e revisäo de literatura / Pelvic Castleman disease: A case report and literature review

A doença de Castleman ou hiperplasia angiofolicular linfóide é uma condiçäo incomum, de etiologia desconhecida, que raramente se manifesta como massa pélvica isolada. Há poucos casos descritos na literatura. Relatamos a ocorrência de doença de Castleman, em pacientes de 35 anos, simulando um tumor anexial. Os aspectos relacionados ao diagnóstico, diagnóstico diferencial e tratamento säo revistos