[Changes of mammographic and ultrasound image of breast in women undergoing hormonal substitution therapy]. / Zmeny mamografického a ultrazvukového obrazu prsní zlázy u zen uzívajících hormonální substitucní terapii.

OBJECTIVE: Evaluation of changes in mammographic and ultrasound images of the breast in women using hormonal substitution therapy (HST). DESIGN: Retrospective clinical study. METHODS: A cohort of 430 women with menopause, who have been using hormonal substitution therapy (HST) for 2-10 years, and the control population of 150 women with menopause not using HST were selected for the study. 304 women used combined HST (an oestrogen and a progestogen combination) and 126 women with surgical menopause used oestrogen hormonal substitution (EST). The mammographic and ultrasound image changes were monitored separately in the women's population with combined and oestrogen hormonal substitution and also in relation to the individual types of breast and relative to the application form of the hormonal preparation. In 105 women with HST, the ultrasound image changes were monitored as well. RESULTS: In women with menopause using HST, there was a statistically significant increase of mammographic image density recorded. It was twice as frequent in the women using the combined HST as in the women using oestrogen monotherapy. In the women using oestrogen substitution, there was a monitorable mammographic density increase in a greater percentage of women with orally used preparation in comparison with the women with intradermal oestrogen administration. The mammographic density increase was more significant in both groups and more frequent in women with a prevalence of fatty breast tissue (type II and III according to Tabár). In ultrasound examination, in women with HST, the incidence of new and enlargement of earlier existing benign formations in the breast was recorded. These ultrasound image changes were twice as frequent in the women with oestrogen monotherapy in comparison with the women with the combined hormonal substitution. Only one woman was diagnosed with carcinoma during HST use. CONCLUSIONS: In the women using the combined as well as oestrogen hormonal substitution, a statistically significant mammographic density increase was shown. The mammography density increase was statistically significantly higher in women using the combined hormonal preparation in comparison with the women with oestrogen monotherapy. Enlargement or incidence was twice as frequent in women with the oestrogen monotherapy.

[Reduced serum dehydroepiandrosterone levels in postmenopausal osteoporosis]. / Snízené hladiny sérového dehydroepiandrosteronu u postmenopauzální osteoporózy.

The decline of the production of several hormones with age has been recently linked to several degenerative processes related to aging including osteoporosis. The aim of our study was to confirm the observations published in 1994 suggesting that postmenopausal women with DHEAS levels below a certain limit have a much higher risk of osteoporosis than those with the levels above this limit. The DHEAS levels were measured by RIA and compared to our own age-adjusted reference ranges. The values lower than 25th quantile were considered "subnormal". More than 500 postmenopausal subjects were included in our study. In those with "subnormal" levels bone mineral density (BMD) was measured on DEXA (Lunar or Hologic). Decreased BMD ranging from osteopenia to severe osteoporosis was found in 86% of 74 women with "subnormal" DHEAS, while the expected frequency in our postmenopausal population may be about 30%. In the following period the serum DHEAS levels were compared with DEXA findings in another 134 postmenopausal women. The DHEAS levels in all stages of decreased BMD were significantly lower than those in the group with normal BMD. The clinical sensitivity and specificity of DHEAS as a marker of increased risk of osteoporosis has been calculated for a cut-off limit of 0.5 MoM. In the light of these findings we believe that the robust and relatively cheap DHEAS determination could help us to identify women who are at higher risk of osteoporosis. Also, in the future, only the women with evidently deficient DHEA production might possibly become candidates for eventual DHEA substitution.