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1.
Ageing Res Rev ; 67: 101301, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33610812

RESUMO

The growing life expectancy in modern societies has raised scientific interest in identifying medical interventions to alleviate age-associated pathologies such as vascular calcification, cognitive decline, sarcopenia, osteoporosis and sexual dysfunction. Although no such single treatment has thus far been established in humans, some clinicians and patients have set their hopes on testosterone replacement therapy (TRT) as a potential "fountain of youth" for aging men. While TRT has proven effective in ameliorating distinct symptoms of late-onset hypogonadism (LOH), its safety remains to be demonstrated. Besides humans, multiple other species exhibit age-related reductions in circulating testosterone levels, raising the question whether such changes are an inherent, pathological feature of growing organismal age or rather reflect an adaptive response. In this manuscript, we apply key principles of evolutionary medicine to testosterone biology and LOH to provide a novel perspective on these two fields. Additionally, we discuss insightful data derived from the animal kingdom to illustrate the plasticity of individual testosterone trajectories across the lifespan, outline cost-benefit-considerations of TRT in LOH and highlight potential caveats of such therapies.


Assuntos
Hipogonadismo , Osteoporose , Adolescente , Envelhecimento , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipogonadismo/tratamento farmacológico , Masculino , Testosterona
2.
Eur J Endocrinol ; 184(1): 79-88, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112259

RESUMO

Objective: Although the overall risk of cancer is not increased in Turner syndrome, the pattern of cancer occurrence differs from the general population. We aim to describe the cancer morbidity pattern in Turner syndrome and evaluate the effect of long-term hormone replacement therapy (HRT). Design: Nationwide epidemiological study. Methods: 1156 females with Turner syndrome diagnosed during 1960-2014, were linked with data from the Danish National Patient Registry. Statistics Denmark randomly identified 115 578 female controls. Stratified Cox regression was used to analyze cancer morbidity, mortality and effect of HRT. Results: Overall risk of cancer was not elevated (hazard ratio 1.04 (95% CI: 0.80-1.36)). The risk of skin cancer and benign skin neoplasms was two-fold increased, while the risk of breast cancer was decreased (hazard ratio 0.4 (0.2-0.9)). Turner syndrome (45,X) had a two- to five-fold increased risk of benign CNS tumors, colon and rectal cancers, benign skin neoplasms and skin cancer. Turner syndrome women with a 45,X/46,XX karyotype had an increased risk of tongue cancer. HRT had no impact on the risk of any cancer investigated in this study. Conclusions: The lack of one X chromosome might play a role in skin neoplasms, CNS tumors, colon and rectal cancers. The risk of breast cancer is lower than in the general population. Long-term HRT during the premenopausal age range seems not to exert a cancerous effect in Turner syndrome. Increased vigilance concerning specific types of cancer in Tuner syndrome harboring a 45,X karyotype is needed.


Assuntos
Hormônios Esteroides Gonadais/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Neoplasias/epidemiologia , Síndrome de Turner/complicações , Síndrome de Turner/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Hormônios Esteroides Gonadais/uso terapêutico , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias/etiologia , Prevalência , Sistema de Registros , Risco , Aberrações dos Cromossomos Sexuais , Síndrome de Turner/epidemiologia , Adulto Jovem
3.
J Sex Med ; 18(1): 83-98, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317996

RESUMO

BACKGROUND: Treatment of "adult-onset hypogonadism" (AOH) with exogenous testosterone therapy (TTh) to raise serum testosterone (T) levels may influence cardiovascular (CV) risk factors in patients with AOH, whereas low endogenous T levels are associated with an increased CV risk and mortality. AIM: To critically evaluate studies reporting increased CV risk associated with TTh and to provide an overview of the risks and benefits of restoring T levels through exogenous TTh. METHODS: A review of publications focusing on the association between TTh and increased CV risk was conducted, and the study methodologies and conclusions of each were critically evaluated. Further, recent clinical and epidemiological studies associating AOH or TTh with a change in CV risk, and pertinent hematologic and vascular effects noted in animal studies and in vitro, as well as in clinical practice were also reviewed. OUTCOMES: A review of the literature shows that untreated testosterone deficiency and/or low T is associated with an increase in CV risk and adverse outcomes, with numerous studies and meta-analyses to support a positive association between exogenous TTh and an improvement in CV risk factors in men with AOH. RESULTS: Numerous studies in the literature demonstrate the positive benefits of using TTh; however, since 2013, some publications have suggested a link to increased CV risk associated with TTh. A number of these studies retrospectively analyzed insurance claims databases using diagnosis codes, procedures codes, and prescription information. Many reviews published since have pointed out the methodological flaws and debatable conclusions of these studies. CLINICAL IMPLICATIONS: A careful assessment of the patient's current health status and CV risk factors should be weighed against the benefits and possible risks resulting from TTh, and consideration should be given to deferring treatment pending resolution or stabilization of CV disease or risk factors. STRENGTHS & LIMITATIONS: In this review, we provide an in-depth analysis of studies reporting increased CV risk with TTh. Many of the studies were not well-designed, randomized, double-blind, prospective clinical trials but rather post hoc analyses of cohort data. These studies may reflect bias in how treatment and nontreatment decisions are made or reflect conclusions based on widely cited methodological flaws. CONCLUSION: Appropriate patient selection supported by low pre-treatment T levels and monitoring T levels during treatment with the goal of achieving and maintaining physiologic levels all contribute to the safe and effective use of TTh in men with AOH. Khera M, Miner M, Jaffe J, et al. Testosterone Therapy and Cardiovascular Risk: A Critical Analysis of Studies Reporting Increased Risk. J Sex med 2021;18:83-98.


Assuntos
Doenças Cardiovasculares , Hipogonadismo , Adulto , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipogonadismo/tratamento farmacológico , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Risco , Testosterona/efeitos adversos
4.
Eur J Epidemiol ; 35(9): 871-878, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32767022

RESUMO

There are conflicting finds in the literature regarding the association of female estrogen status and the incidence of Parkinson's disease (PD). We aimed to investigate whether female reproductive factors are associated with PD. Using the Korean National Health Insurance System database, 4,729,546 postmenopausal women without PD were identified. The new incidence of PD was defined as subjects with an ICD-10 code for PD (G20) and with a rare intractable disease registration code for PD (V124). The Cox proportional hazard models were used to evaluate the associations of various reproductive factors with incidence of PD. During the median follow-up of 5.84 years, 20,816 individuals were diagnosed with PD. An increased risk of PD was observed in subjects with a later age at menarche (≥ 17 years) compared with reference subjects (13 years ≤ age at menarche ≤ 14 years) (adjusted hazard ratio, aHR 1.10, 95% confidence interval, CI 1.05-1.16). As age at menopause increased, risk of PD decreased (P for trend 0.019). Consistently, decreased risk of PD was observed (aHR 0.91, 95% CI 0.85-0.96) in subjects with longer duration of fertility (≥ 40 years of age) compared with shorter duration of fertility (< 30 years of age). Hormone replacement therapy and oral contraceptives independently increased the risk of PD by 17% and 7%, respectively. Female reproductive factors are independent risk factors for PD, with higher risk associated with shorter lifetime exposure to endogenous estrogen.


Assuntos
Anticoncepcionais Orais/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Menarca , Menopausa , Doença de Parkinson/epidemiologia , História Reprodutiva , Adulto , Idoso , Estudos de Coortes , Anticoncepcionais Orais/administração & dosagem , Feminino , Terapia de Reposição Hormonal/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Doença de Parkinson/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
5.
Eur J Endocrinol ; 183(4): 471-480, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32738133

RESUMO

Context: Growth hormone (GH) deficiency is a common late effect of cranial irradiation. However, concerns have been raised that GH treatment might lead to an increased risk of a second neoplasm (SN). Objective: To study the impact of GH treatment on the risk of SN in a French cohort of survivors of childhood cancer (CCS) treated before 1986. Design and setting: Cohort study and nested case-control study. Participants: Of the 2852 survivors, with a median follow-up of 26 years, 196 had received GH therapy (median delay from cancer diagnosis: 5.5 years). Main outcome measures: Occurrence of SN. Results: In total, 374 survivors developed a SN, including 40 who had received GH therapy. In a multivariate analysis, GH treatment did not increase the risk of secondary non-meningioma brain tumors (RR: 0.6, 95% CI: 0.2-1.5, P = 0.3), secondary non-brain cancer (RR: 0.7, 95% CI: 0.4-1.2, P = 0.2), or meningioma (RR: 1.9, 95% CI: 0.9-4, P = 0.09). Nevertheless, we observed a slight non-significant increase in the risk of meningioma with GH duration: 1.6-fold (95% CI: 1.2-3.0) after an exposure of less than 4 years vs 2.3-fold (95% CI: 0.9-5.6) after a longer exposure (P for trend = 0.07) confirmed by the results of a case-control study. Conclusion: This study confirms the overall safety of GH use in survivors of childhood cancer, which does not increase the risk of a SN. The slight excess in the risk of meningioma in patients with long-term GH treatment is non-significant and could be due to difficulties in adjustment on cranial radiation volume/dose and/or undiagnosed meningioma predisposing conditions.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Hormônio do Crescimento Humano/uso terapêutico , Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/induzido quimicamente , Neoplasias Encefálicas/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Irradiação Craniana/efeitos adversos , Feminino , Seguimentos , França/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias Meníngeas/induzido quimicamente , Neoplasias Meníngeas/epidemiologia , Meningioma/induzido quimicamente , Meningioma/epidemiologia , Pessoa de Meia-Idade , Segunda Neoplasia Primária/induzido quimicamente , Estudos Retrospectivos , Adulto Jovem
7.
JAMA ; 324(4): 369-380, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32721007

RESUMO

Importance: The influence of menopausal hormone therapy on breast cancer remains unsettled with discordant findings from observational studies and randomized clinical trials. Objective: To assess the association of prior randomized use of estrogen plus progestin or prior randomized use of estrogen alone with breast cancer incidence and mortality in the Women's Health Initiative clinical trials. Design, Setting, and Participants: Long-term follow-up of 2 placebo-controlled randomized clinical trials that involved 27 347 postmenopausal women aged 50 through 79 years with no prior breast cancer and negative baseline screening mammogram. Women were enrolled at 40 US centers from 1993 to 1998 with follow-up through December 31, 2017. Interventions: In the trial involving 16 608 women with a uterus, 8506 were randomized to receive 0.625 mg/d of conjugated equine estrogen (CEE) plus 2.5 mg/d of medroxyprogesterone acetate (MPA) and 8102, placebo. In the trial involving 10 739 women with prior hysterectomy, 5310 were randomized to receive 0.625 mg/d of CEE alone and 5429, placebo. The CEE-plus-MPA trial was stopped in 2002 after 5.6 years' median intervention duration, and the CEE-only trial was stopped in 2004 after 7.2 years' median intervention duration. Main Outcomes and Measures: The primary outcome was breast cancer incidence (protocol prespecified primary monitoring outcome for harm) and secondary outcomes were deaths from breast cancer and deaths after breast cancer. Results: Among 27 347 postmenopausal women who were randomized in both trials (baseline mean [SD] age, 63.4 years [7.2 years]), after more than 20 years of median cumulative follow-up, mortality information was available for more than 98%. CEE alone compared with placebo among 10 739 women with a prior hysterectomy was associated with statistically significantly lower breast cancer incidence with 238 cases (annualized rate, 0.30%) vs 296 cases (annualized rate, 0.37%; hazard ratio [HR], 0.78; 95% CI, 0.65-0.93; P = .005) and was associated with statistically significantly lower breast cancer mortality with 30 deaths (annualized mortality rate, 0.031%) vs 46 deaths (annualized mortality rate, 0.046%; HR, 0.60; 95% CI, 0.37-0.97; P = .04). In contrast, CEE plus MPA compared with placebo among 16 608 women with a uterus was associated with statistically significantly higher breast cancer incidence with 584 cases (annualized rate, 0.45%) vs 447 cases (annualized rate, 0.36%; HR, 1.28; 95% CI, 1.13-1.45; P < .001) and no significant difference in breast cancer mortality with 71 deaths (annualized mortality rate, 0.045%) vs 53 deaths (annualized mortality rate, 0.035%; HR, 1.35; 95% CI, 0.94-1.95; P= .11). Conclusions and Relevance: In this long-term follow-up study of 2 randomized trials, prior randomized use of CEE alone, compared with placebo, among women who had a previous hysterectomy, was significantly associated with lower breast cancer incidence and lower breast cancer mortality, whereas prior randomized use of CEE plus MPA, compared with placebo, among women who had an intact uterus, was significantly associated with a higher breast cancer incidence but no significant difference in breast cancer mortality.


Assuntos
Neoplasias da Mama/epidemiologia , Estrogênios Conjugados (USP)/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Histerectomia , Acetato de Medroxiprogesterona/efeitos adversos , Idoso , Neoplasias da Mama/induzido quimicamente , Neoplasias da Mama/mortalidade , Neoplasias da Mama/prevenção & controle , Estrogênios Conjugados (USP)/uso terapêutico , Feminino , Seguimentos , Humanos , Histerectomia/efeitos adversos , Incidência , Acetato de Medroxiprogesterona/uso terapêutico , Pessoa de Meia-Idade , Pós-Menopausa , Risco
11.
Breast Cancer Res Treat ; 181(2): 475-485, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32328847

RESUMO

PURPOSE: Large-scale population-based registry studies investigating the risk of breast cancer after removal of both ovaries at hysterectomy for benign conditions in women with no known genetic predisposition to cancer are needed. We aimed to perform such a study taking into account the age at surgery status and use of hormone replacement therapy (HRT). METHODS: Within the female population of Denmark born 1937-1996, we evaluated breast cancer incidence after unilateral or bilateral oophorectomy concomitant with or after benign hysterectomy in comparison with no surgery and with hysterectomy alone using health registry data during 1978-2016. In a subpopulation followed from 1996, the analyses were stratified according to use of HRT. RESULTS: We found a reduced risk of breast cancer among women aged < 45 years at bilateral oophorectomy compared with women with hysterectomy alone (HR = 0.78; 95% CI 0.66, 0.92), whereas slightly increased risks were seen in women above 50 years. In the subpopulation, non-users of HRT aged ≥ 50 years at oophorectomy had a HR of 0.74 (95% CI 0.56, 0.98) for breast cancer after bilateral oophorectomy compared with hysterectomy alone. CONCLUSIONS: Our large-scale study covering four decades provides evidence that bilateral oophorectomy performed at young age in women with benign indications for hysterectomy is associated with a reduction in breast cancer risk. The finding of a negative association at older ages in women not using HRT deserves further attention.


Assuntos
Neoplasias da Mama/epidemiologia , Terapia de Reposição Hormonal/efeitos adversos , Histerectomia/efeitos adversos , Ovariectomia/efeitos adversos , Adulto , Idoso , Neoplasias da Mama/etiologia , Neoplasias da Mama/prevenção & controle , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Adulto Jovem
12.
Am J Surg Pathol ; 44(8): 1040-1049, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32282346

RESUMO

Prostatic-type differentiation in the lower female genital tract is encountered rarely and its causes and clinical associations are not well established. Within the vagina, reports to date have invariably described ectopic prostatic-type differentiation as restricted to the lamina propria. We recently encountered a patient receiving testosterone for gender dysphoria whose vaginectomy specimen showed a prostatic glandular proliferation within the surface epithelium. To elucidate its potential association with androgen exposure, we sought similar lesions, resected over a 26-year period, from patients with exogenous or endogenous androgen excess. Thirteen cases were identified, involving the vagina (n=12) and exocervix (n=1). The most common clinical context was gender dysphoria with long-term testosterone therapy; the lesion was present in 7 of 8 gender-dysphoric patients examined. Four other patients had congenital disorders of sexual development associated with endogenous androgen excess (congenital adrenal hyperplasia, 46,XY disorder of sexual development, and ovotesticular disorder of sexual development). Two had no known exposure to androgen excess. Immunohistochemically, glands stained for NKX3.1 (100% of cases), androgen receptor (100%), CK7 (92%), and prostate-specific antigen (69%). Follow-up (median duration, 11 mo) showed no masses or neoplasia. We propose the designation "androgen-associated prostatic metaplasia" for this form of prostate tissue with distinctive clinical, histologic and immunohistochemical features. It is novel and previously unrecognized within the vagina. It is strikingly prevalent among patients undergoing gender-affirming surgery, an increasingly common procedure. Recognition is important to distinguish it from other potentially neoplastic glandular lesions and facilitate accrual of more follow-up data to better understand its natural history.


Assuntos
Diferenciação Celular , Coristoma/patologia , Células Epiteliais/patologia , Próstata , Doenças do Colo do Útero/patologia , Doenças Vaginais/patologia , Adolescente , Adulto , Androgênios/administração & dosagem , Androgênios/efeitos adversos , Diferenciação Celular/efeitos dos fármacos , Criança , Coristoma/induzido quimicamente , Células Epiteliais/efeitos dos fármacos , Feminino , Disforia de Gênero/tratamento farmacológico , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Masculino , Metaplasia , Fatores de Risco , Testosterona/administração & dosagem , Testosterona/efeitos adversos , Transexualidade/tratamento farmacológico , Doenças do Colo do Útero/induzido quimicamente , Doenças Vaginais/induzido quimicamente , Adulto Jovem
14.
J Clin Res Pediatr Endocrinol ; 12(Suppl 1): 46-49, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32041392

RESUMO

In adolescents and young women, there is limited data on the type of replacement, route of administration, and ideal doses to be used in systemic hormone therapy administered for the treatment of hypogonadism. In particular, management of patients with complicated systemic diseases or at risk of thrombophilia may present significant challenges. We present a case of a 15-year-old adolescent girl with hypogonadism and coexisting medical conditions, who was evaluated for systemic hormone therapy.


Assuntos
Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Adolescente , Fator V/genética , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Tromboembolia Venosa/induzido quimicamente
15.
Artigo em Inglês | MEDLINE | ID: mdl-32107136

RESUMO

Endometrial cancer (EC) is the most common gynaecological malignancy, and its incidence is rising alongside the growing prevalence of obesity. Effective risk-reducing interventions hijacking the key mechanisms driving endometrial carcinogenesis may affect EC diagnoses if aimed at those at greatest risk. An understanding of the key risk factors and their role in tumourigenesis is critical in developing such prevention strategies. In this review, we summarise the major risk factors for EC and the evidence for available risk-reducing interventions in high-risk women. We suggest potential prevention strategies and make a case for the need for risk prediction models that identify specific groups of women at a particularly high risk of EC for whom risk-reducing interventions are likely to have a significant impact.


Assuntos
Neoplasias do Endométrio/prevenção & controle , Endométrio/patologia , Terapia de Reposição Hormonal/efeitos adversos , Histerectomia , Obesidade/prevenção & controle , Salpingo-Ooforectomia , Neoplasias do Endométrio/genética , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Fatores de Risco
16.
Sci Rep ; 10(1): 1348, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992764

RESUMO

Obesity is known to increase breast cancer risk and aggressiveness in postmenopausal luminal breast cancer and obesity-driven dysfunctional metabolic activity in visceral adipose tissue (VAT) is considered as one of the principal underlying mechanism. We aimed to investigate the relationship between VAT metabolic activity evaluated by preoperative 18F-FDG PET/CT and axillary lymph node (ALN) metastasis in postmenopausal luminal breast cancer patients. In total, 173 patients were enrolled in study. They all underwent preoperative 18F-FDG PET/CT and surgery. VAT metabolic activity was defined as the maximum standardized uptake value (SUVmax) of VAT divided by the SUVmax of subcutaneous adipose tissue (V/S ratio). In luminal breast cancer, the patients with ALN metastasis showed significantly higher V/S ratio than the patients without ALN metastasis. Furthermore, V/S ratio was significantly associated with ALN metastasis in luminal breast cancer patients. Erythrocyte sedimentation rate, which reflect the systemic inflammation, was significantly higher in ALN metastasis group than the negative ALN metastasis group in luminal breast cancer patients and showed significant positive correlation with V/S ratio. V/S ratio significantly affects the ALN metastasis status in postmenopausal luminal breast cancer patients and it may be useful as a potential biomarker of obesity-driven systemic inflammation associated with tumor aggressiveness.


Assuntos
Axila/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/metabolismo , Metabolismo Energético , Gordura Intra-Abdominal/metabolismo , Linfonodos/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Biomarcadores , Índice de Massa Corporal , Neoplasias da Mama/etiologia , Feminino , Fluordesoxiglucose F18 , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Pós-Menopausa , Prognóstico
17.
Pediatr Blood Cancer ; 67(4): e28137, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31889398

RESUMO

BACKGROUND: The advent of techniques for the assessment of iron overload (liver T2*-MRI) has led to the awareness that focal nodular hyperplasia (FNH) represents a possible incidental finding after hematopoietic stem cell transplantation (HSCT), though its pathogenesis is still unclear. METHODS: We performed a retrospective analysis of the liver T2*-MRI scans performed between 2013 and 2018 in a single pediatric HSCT Unit and recorded the number of patients with FNH (group A). Patients incidentally diagnosed with FNH at imaging performed for different clinical indications were included in group B. RESULTS: Nine of 105 (8.6%) patients from group A were diagnosed with FNH. Group B included three patients. Overall, 12 patients were diagnosed 4.4 ± 3.1 years after HSCT. At univariate analysis, female gender (odds ratio [OR] 3.77, P = .03), moderate-to-severe iron overload (OR 6.97, P = .01), and hormone replacement therapy (HRT) administered for at least 6 months (OR 18.20, P = .0002) exposed patients to a higher risk of developing FNH. The detrimental effect of HRT was significant also at multivariate analysis (OR 7.93, P = .024). MRI-T2* values in affected patients were statistically lower than healthy controls (P < .001). CONCLUSIONS: We confirm the high incidence of FNH among transplanted pediatric patients and demonstrate the potential pathogenic role of HRT and iron overload.


Assuntos
Hiperplasia Nodular Focal do Fígado/diagnóstico , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Terapia de Reposição Hormonal/efeitos adversos , Sobrecarga de Ferro/fisiopatologia , Criança , Feminino , Hiperplasia Nodular Focal do Fígado/etiologia , Seguimentos , Neoplasias Hematológicas/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Prognóstico , Estudos Retrospectivos
18.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794605

RESUMO

CONTEXT: As many sports are divided in male/female categories, governing bodies have formed regulations on the eligibility for transgender individuals to compete in these categories. Yet, the magnitude of change in muscle mass and strength with gender-affirming treatment remains insufficiently explored. OBJECTIVE: This study explored the effects of gender-affirming treatment on muscle function, size, and composition during 12 months of therapy. DESIGN, SETTINGS, PARTICIPANTS: In this single-center observational cohort study, untrained transgender women (TW, n = 11) and transgender men (TM, n = 12), approved to start gender-affirming medical interventions, underwent assessments at baseline, 4 weeks after gonadal suppression of endogenous hormones but before hormone replacement, and 4 and 12 months after treatment initiation. MAIN OUTCOME MEASURES: Knee extensor and flexor strength were assessed at all examination time points, and muscle size and radiological density (using magnetic resonance imaging and computed tomography) at baseline and 12 months after treatment initiation. RESULTS: Thigh muscle volume increased (15%) in TM, which was paralleled by increased quadriceps cross-sectional area (CSA) (15%) and radiological density (6%). In TW, the corresponding parameters decreased by -5% (muscle volume) and -4% (CSA), while density remained unaltered. The TM increased strength over the assessment period, while the TW generally maintained their strength levels. CONCLUSIONS: One year of gender-affirming treatment resulted in robust increases in muscle mass and strength in TM, but modest changes in TW. These findings add new knowledge on the magnitude of changes in muscle function, size, and composition with cross-hormone therapy, which could be relevant when evaluating the transgender eligibility rules for athletic competitions.


Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Força Muscular/efeitos dos fármacos , Músculo Esquelético/efeitos dos fármacos , Procedimentos de Readequação Sexual/efeitos adversos , Transexualidade/tratamento farmacológico , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Procedimentos de Readequação Sexual/métodos , Transexualidade/fisiopatologia , Resultado do Tratamento
20.
Int J Clin Pract ; 74(3): e13449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31755635

RESUMO

BACKGROUND: From the primary care perspective, many urologists and oncologists appear to be ignoring an FDA warning to assess patients' cardiovascular (CV) risk before instituting androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists. A growing body of data suggest an association between ADT and CV/cardiometabolic risk, particularly for GnRH agonists. METHODOLOGY: The author examined available evidence regarding CV side effects with GnRH agonists and antagonists to determine what urologists, medical oncologists, primary care physicians (PCPs) and patients need to know about these risks. RESULTS: Data are inconclusive and somewhat conflicting-for example, both low testosterone and testosterone replacement have been associated with elevated CV risk. But the distinction between GnRH agonists and antagonists is becoming clearer, as agonists appear to be more strongly linked with CV risk, perhaps due to the transient testosterone surge they cause upon administration. Moreover, adverse CV events associated with GnRH agonists can emerge relatively quickly, within weeks to months. Conversely, two studies show that GnRH antagonists may significantly reduce CV risk compared to GnRH agonists. CONCLUSIONS: Both GnRH agonists and antagonists carry some degree of CV risk. Although the risk appears to be lower with GnRH antagonists, urologists and oncologists should communicate with PCPs to determine patients' baseline CV risk levels before implementing ADT with either type of agent.


Assuntos
Antagonistas de Androgênios/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Hormônio Liberador de Gonadotropina/efeitos adversos , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Terapia de Reposição Hormonal/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Medicina Baseada em Evidências , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológico , Medição de Risco , Fatores de Risco
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