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1.
Medicine (Baltimore) ; 98(51): e17532, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860945

RESUMO

BACKGROUND: Discordant results about the causal relationship between hormone replacement therapy use (HRT) and lung cancer risk in women had been reported. We therefore conducted a meta-analysis of cohort studies to evaluate this association. METHODS: The PubMed and Embase databases were searched. Fixed- or random-effects model was used to pool the study-specific relative risks (RRs) with corresponding 95% confidence intervals (CIs). Sensitivity analysis, publication bias, and subgroup analysis were performed. RESULTS: A total of 13 cohort studies met the inclusion criteria. Combined results indicated that compared with nonusers, women with HRT use were at a decreased risk (RR: 0.95, 95% CI: 0.91-0.99, I = 30.8%, P for heterogeneity = .137). In subgroup analysis by geographic area, smoking statue, type of hormones, and histology type of lung cancer, no significant association between HRT use and lung cancer was observed in most subgroups except in those studies which reported risk estimates adjusted for age, body mass index, smoking, and other confounders (RR: 0.95, 95 CI: 0.91-0.99, I = 33.0%, P for heterogeneity = .214). Both Begg funnel plot and Egger test (P = .243) suggested no evidence for publication bias. CONCLUSION: Our meta-analysis suggests ever use of HRT is associated with a decreased risk of lung cancer in women.


Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Feminino , Humanos , Neoplasias Pulmonares/fisiopatologia , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Prevalência , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Análise de Sobrevida
2.
J Med Case Rep ; 13(1): 311, 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31623668

RESUMO

BACKGROUND: Levothyroxine is a synthetic thyroxine and is the treatment of choice for hypothyroidism. It is a prohormone with minimal intrinsic activity. The drug is de-iodinated in peripheral tissue to form triiodothyronine, which is the active thyroid hormone. On initiation of treatment, levothyroxine is titrated, and usually it is extremely well tolerated in the vast majority of patients. We report a case of a patient with self-limiting levothyroxine-induced liver injury, a rare adverse effect of this drug. CASE PRESENTATION: We report a case of a 34-year-old Mediterranean woman diagnosed with post-thyroidectomy hypothyroidism. She was commenced on levothyroxine and developed liver injury confirmed by noninvasive liver investigations. Complete recovery of the patient's liver tests occurred upon cessation of the drug. Triiodothyronine was an appropriate treatment alternative. CONCLUSION: Levothyroxine-induced liver injury is a rare, and in the present case report, a self-limiting, adverse effect. The diagnosis of our patient was confirmed via noninvasive diagnostic methods. Knowledge of this rare adverse effect is important in the differential diagnosis of patients who have commenced on levothyroxine and have deranged liver enzymes in the context of hypothyroidism.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Terapia de Reposição Hormonal/efeitos adversos , Hipotireoidismo/tratamento farmacológico , Tiroxina/efeitos adversos , Adulto , Feminino , Humanos , Hipotireoidismo/etiologia , Tireoidectomia , Tri-Iodotironina/uso terapêutico
3.
Drugs Aging ; 36(11): 981-989, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595418

RESUMO

The number of older adults over 65 years of age is expected to increase to almost 100 million in the US by 2050, more than double the current figure of 46 million. Advanced age is associated with increased frailty among older Americans and often leads to increased disability, hospitalization, institutionalization, and, eventually, mortality. In search of means to improve age-related risks for adverse health outcomes, the question of restoring diminishing sex hormones has gathered much interest and has led to the practice of sex hormone replacement therapies in older men. Recent data suggest that androgen prescription rates in the US for men older than 60 years of age quadrupled from the years 2001 to 2011. While prescription sales of testosterone have increased from $150 million in 2000 to $1.8 billion in 2011, a significant portion of men prescribed testosterone replacement therapy did not meet the laboratory criteria for hypogonadism. While some clinical trials reported an association between testosterone insufficiency in older men and increased risk of death, the exact effects and consequences of testosterone replacement therapy, specifically in older men, remain unclear. This review is aimed at discussing the possible benefits and complications of testosterone replacement therapy in older men over 60 years of age.


Assuntos
Androgênios/uso terapêutico , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Testosterona/uso terapêutico , Idoso , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Humanos , Hipogonadismo/metabolismo , Masculino , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
5.
BMC Cancer ; 19(1): 984, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640608

RESUMO

BACKGROUND: Ovarian cancer (OC) is the seventh most common malignancy worldwide and the most lethal gynaecological malignancy. We aimed to explore global geographical patterns and temporal trends from 1973 to 2015 for 41 countries in OC incidence and especially to analyse the birth cohort effect to gain further insight into the underlying causal factors of OC and identify countries with increasing risk of OC. METHODS: OC data were drawn from the Cancer Incidence in Five Continents databases and online databases published by governments. The joinpoint regression model was applied to detect changes in OC trends. The age-period-cohort model was applied to explore age and birth cohort effects. RESULTS: The age-standardized rate of OC incidence ranged from 3.0 to 11.4 per 100,000 women worldwide in 2012. The highest age-standardized rate was observed in Central and Eastern Europe, with 11.4 per 100,000 women in 2012. For the most recent 10-year period, the increasing trends were mainly observed in Central and South America, Asia and Central and Eastern Europe. The largest significant increase was observed in Brazil, with an average annual percentage change of 4.4%. For recent birth cohorts, cohort-specific increases in risk were pronounced in Estonia, Finland, Iceland, Lithuania, the United Kingdom, Germany, the Netherlands, Italy, Malta, Slovenia, Bulgaria, Russia, Australia, New Zealand, Brazil, Costa Rica, Ecuador, India, Japan, the Philippines and Thailand. CONCLUSIONS: Disparities in the incidence and risk of OC persist worldwide. The increased risk of birth cohort in OC incidence was observed for most countries in Asia, Central and Eastern Europe, and Central and South America. The reason for the increasing OC risk for recent birth cohorts in these countries should be investigated with further epidemiology studies.


Assuntos
Saúde Global/tendências , Neoplasias Ovarianas/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Anticoncepcionais Orais , Dieta/efeitos adversos , Feminino , Disparidades nos Níveis de Saúde , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Incidência , Pessoa de Meia-Idade , Obesidade/complicações , Neoplasias Ovarianas/prevenção & controle , Paridade , Gravidez , Fatores de Risco , Fumar/efeitos adversos , Adulto Jovem
7.
Breast ; 47: 43-55, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31344603

RESUMO

Due to the higher incidence of hormone responsive tumours in women >50, the safety of hormone replacement therapy (HRT) in older breast cancer survivors may differ from younger age groups. The primary outcome in this review was the risk of tumour recurrence and secondary outcome the relationship with breast cancer-related mortality. Medline, CINAHL, Cochrane, Google Scholar and EMBASE databases were searched through August 2018 for studies reporting exposure to HRT in survivors ≥50 at primary diagnosis. Random effects models were used to estimate the combined relative risk (RR) of tumour recurrence and breast cancer-related mortality using the Mantel-Haenszel method and the quality of evidence determined for the primary outcome. Overall, nine studies (four cohort, one case-control, four RCTs; n = 16,002) were included. Very low quality evidence from observational studies demonstrated no adverse effect on tumour recurrence with HRT use (RR 0.80, 95% CI 0.53 to 1.19; I2 = 66%; n = 11,984), while moderate quality evidence from RCTS demonstrated an adverse effect (RR 1.46, 95% CI 1.20 to 1.77; I2 = 17%; n = 4108). Similarly, observational studies demonstrated no adverse effect on breast cancer-related mortality (RR 0.32, 95% CI 0.21 to 1.49; I2 = 0%, n = 2182), while RCTs demonstrated a non-significant higher risk (RR 1.07, 95% CI 0.77 to 1.49; I2 = 0%; n = 3918). Ultimately, despite conflicting findings, evidence of sufficient quality suggests that HRT may increase the risk of tumour recurrence in older survivors. However, adverse effect on mortality is unlikely. Caution with HRT use in survivors is further advised.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Sobreviventes de Câncer , Terapia de Reposição Hormonal/efeitos adversos , Recidiva Local de Neoplasia/induzido quimicamente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Casos e Controles , Intervalo Livre de Doença , Feminino , Seguimentos , Avaliação Geriátrica , Terapia de Reposição Hormonal/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Análise de Sobrevida
8.
Eur J Epidemiol ; 34(9): 871-878, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31165323

RESUMO

Incidence of non-alcoholic fatty liver disease (NAFLD) and liver cancer are 2-3 times higher in males than females. Hormonal mechanisms are hypothesized, with studies suggesting that oophorectomy may increase risk, but population-based evidence is limited. Thus, we conducted a study within the Clinical Practice Research Datalink, with controls matched to cases of NAFLD (n = 10,082 cases/40,344 controls) and liver cancer (n = 767 cases/3068 controls). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. Effect measure modification by menopausal hormone therapy (MHT) was examined, using likelihood ratio tests and relative excess risk due to interaction (RERI). Oophorectomy was associated with a 29% elevated NAFLD risk (OR = 1.29, 95% CI 1.18-1.43), which was more pronounced in women without diabetes (OR = 1.41, 95% CI 1.27-1.57) and in women who had oophorectomy prior to age 50 (OR = 1.37, 95% CI 1.22-1.52). Compared to women without oophorectomy or MHT use, oophorectomy and MHT were each associated with over 50% elevated risk of NAFLD. However, the combination of oophorectomy and MHT showed evidence of a negative interaction on the multiplicative (p = 0.003) and additive scales (RERI = - 0.28, 95% CI - 0.60 to 0.03, p = 0.08). Oophorectomy, overall, was not associated with elevated liver cancer risk (OR = 1.16, 95% CI 0.79-1.69). These findings suggest that oophorectomy may increase the risk of NAFLD, but not liver cancer.


Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Neoplasias Hepáticas/induzido quimicamente , Hepatopatia Gordurosa não Alcoólica/induzido quimicamente , Ovariectomia/efeitos adversos , Ovário/cirurgia , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Neoplasias Hepáticas/epidemiologia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fatores de Risco , Saúde da Mulher
9.
Cochrane Database Syst Rev ; 6: CD011009, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31236916

RESUMO

BACKGROUND: Thyroid disease is the second most common endocrine disorder affecting women of reproductive age. Subclinical hypothyroidism is diagnosed by an elevated thyroid-stimulating hormone concentration with a normal concentration of free thyroxine hormone. Autoimmune thyroid disease (ATD) is diagnosed by the presence of thyroid autoantibodies, regardless of thyroid hormone levels. Thyroxine may be a useful treatment for subfertile women with these two specific types of thyroid disease for improving pregnancy outcomes during assisted reproduction. OBJECTIVES: To evaluate the efficacy and harms of levothyroxine replacement in subfertile women with subclinical hypothyroidism or with normal thyroid function and thyroid autoimmunity (euthyroid autoimmune thyroid disease, or euthyroid ATD) undergoing assisted reproduction. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers together with reference checking and contact with study authors and experts in the field to identify studies. We searched for all published and unpublished randomised controlled trials (RCTs) comparing thyroxine with no treatment or placebo, without language restrictions, from inception to 8 April 2019, and in consultation with the Cochrane CGF Information Specialist. SELECTION CRITERIA: We included women undergoing assisted reproduction treatment, meaning both in vitro fertilisation and intracytoplasmic sperm injection, with a history of subfertility and with subclinical hypothyroidism or with euthyroid ATD. We excluded women with a previously known clinical hypothyroidism or already taking thyroxine or tri-iodothyronine. RCTs compared thyroxine (levothyroxine) with either placebo or no treatment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary review outcomes were live birth and adverse events of thyroxine; our secondary outcomes were clinical pregnancy, multiple pregnancy and miscarriage. MAIN RESULTS: The review included four studies with 820 women. The included studies were of overall low risk of bias. Using GRADE methodology, we assessed the quality of evidence for the primary outcomes of this review to be very low- to low-quality evidence. Evidence was downgraded for imprecision as it was based on single, small trials with wide confidence intervals (CI). We were able to include data from three of the four included studies.In one study of women with both subclinical hypothyroidism and positive or negative anti-TPO antibodies (autoimmune disease), the evidence suggested that thyroxine replacement may have improved live birth rate (RR 2.13, 95% CI 1.07 to 4.21; 1 RCT, n = 64; low-quality evidence) and it may have led to similar miscarriage rates (RR 0.11, 95% CI 0.01 to 1.98; 1 RCT, n = 64; low-quality evidence). The evidence suggested that women with both subclinical hypothyroidism and positive or negative anti-TPO antibodies would have a 25% chance of a live birth with placebo or no treatment, and that the chance of a live birth in these women using thyroxine would be between 27% and 100%.In women with normal thyroid function and thyroid autoimmunity (euthyroid ATD), treatment with thyroxine replacement compared with placebo or no treatment may have led to similar live birth rates (risk ratio (RR) 1.04, 95% CI 0.83 to 1.29; 2 RCTs, number of participants (n) = 686; I2 = 46%; low-quality evidence) and miscarriage rates (RR 0.83, 95% CI 0.47 to 1.46, 2 RCTs, n = 686, I2 = 0%; low-quality evidence). The evidence suggested that women with normal thyroid function and thyroid autoimmunity would have a 31% chance of a live birth with placebo or no treatment, and that the chance of a live birth in these women using thyroxine would be between 26% and 40%.Adverse events were rarely reported. One RCT reported 0/32 in the thyroxine replacement group and 1/32 preterm births in the control group in women diagnosed with subclinical hypothyroidism and positive or negative anti-TPO antibodies. One RCT reported 21/300 preterm births in the thyroxine replacement group and 19/300 preterm births in the control group in women diagnosed with positive anti-TPO antibodies. None of the RCTs reported on other maternal pregnancy complications, foetal complications or adverse effects of thyroxine. AUTHORS' CONCLUSIONS: We could draw no clear conclusions in this systematic review due to the very low to low quality of the evidence reported.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Terapia de Reposição Hormonal , Hipotireoidismo/tratamento farmacológico , Infertilidade Feminina/tratamento farmacológico , Doenças da Glândula Tireoide/tratamento farmacológico , Tiroxina/uso terapêutico , Aborto Espontâneo/epidemiologia , Feminino , Fertilização In Vitro , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipotireoidismo/sangue , Nascimento Vivo/epidemiologia , Gravidez , Gravidez Múltipla , Ensaios Clínicos Controlados Aleatórios como Assunto , Técnicas de Reprodução Assistida , Injeções de Esperma Intracitoplásmicas , Doenças da Glândula Tireoide/sangue , Glândula Tireoide/imunologia , Tireotropina/sangue , Tiroxina/efeitos adversos , Tiroxina/sangue
10.
Minerva Endocrinol ; 44(2): 199-204, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31099529

RESUMO

BACKGROUND: In this study we aimed to evaluate the efficacy of Pycnogenol® supplementation in controlling oxidative stress levels and in reducing the frequency and severity of side effects of levothyroxine (LT4) treatment in patients who had recently started this therapy. METHODS: The registry included 60 females affected by primary hypothyroidism with multi-nodular goiter. LT4 was administered at the dosage of 100 µg/day.The registry study included only subjects under initial treatment, and followed up for a period of at least 30 days. A group took 150 mg Pycnogenol® daily and another served as control. RESULTS: The global occurrence of symptoms during the 30-day period was significantly lower with the supplement (P<0.05). CONCLUSIONS: Pycnogenol® may represent a useful tool to reduce LT4- related side effects in patients treated with hormone replacement therapy for hypothyroidism.


Assuntos
Antioxidantes/uso terapêutico , Flavonoides/uso terapêutico , Hipotireoidismo/tratamento farmacológico , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/uso terapêutico , Tiroxina/efeitos adversos , Tiroxina/uso terapêutico , Suplementos Nutricionais , Feminino , Bócio/complicações , Bócio/tratamento farmacológico , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/metabolismo , Pessoa de Meia-Idade , Hormônios Tireóideos/sangue
11.
Acta Biomed ; 90(2): 228-232, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31125000

RESUMO

BACKGROUND: Hormonal treatment of hypogonadism in thalassaemia major (TM) is a complex issue due to the co-existence of other contributing factors such as severity of iron overload, associated chronic liver disease and other endocrine complications. OBJECTIVES: Data about adverse events (AEs) of testosterone replacement therapy (TRT) in hypogonadal males with TM is scarce.We report the adverse events registered during TRT in 95 young patients with TM. RESULTS: These AEs included gynecomastia, documented in 41/95 (43.1%) TM patients of mild to moderate severity (90%). Persistent pain in the injection site and local reactions to testosterone (T) skin patch occurred in a third of patients. Priapism was reported in 2 patients on treatment with intramuscular T enanthate. In both patients, substitution with T gel was successful, and no recurrence during the following 24 months was observed. CONCLUSIONS: Clinicians should exercise caution when considering TRT for hypogonadal men with TM. (www.actabiomedica.it).


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Terapia de Reposição Hormonal/efeitos adversos , Hipogonadismo/tratamento farmacológico , Hipogonadismo/epidemiologia , Testosterona/efeitos adversos , Talassemia beta/epidemiologia , Adolescente , Estudos de Coortes , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/fisiopatologia , Terapia de Reposição Hormonal/métodos , Humanos , Hipogonadismo/diagnóstico , Masculino , Monitorização Fisiológica/métodos , Segurança do Paciente , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Testosterona/administração & dosagem , Resultado do Tratamento , Adulto Jovem , Talassemia beta/diagnóstico
12.
J Surg Res ; 242: 166-171, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31078901

RESUMO

BACKGROUND: Levothyroxine (LT4) is one of the most prescribed drugs in the United States; however, many patients started on LT4 after thyroidectomy suffer from symptoms of hyper- or hypo-thyroidism before achieving euthyroidism. This study aims to describe the time required for dose adjustment before achieving euthyroidism and identify predictors of prolonged dose adjustment (PDA+) after thyroidectomy. METHODS: This is a single institution retrospective cohort study of patients who achieved euthyroidism with LT4 therapy between 2008 and 2017 after total or completion thyroidectomy for benign disease. Patients who needed at least three dose adjustments (top quartile) were considered PDA+. Binomial logistic regression was used to identify predictors of PDA+. RESULTS: The 605 patients in this study achieved euthyroidism in a median of 116 d (standard deviation 124.9) and one dose adjustment (standard deviation 1.3). The 508 PDA- patients achieved euthyroidism in a median of 101 d and one dose adjustment. The 97 PDA+ patients achieved euthyroidism in a median of 271 d and three dose adjustments. Iron supplementation (odds ratio = 4.4, 95% confidence interval = 1.4-13.5, P = 0.010) and multivitamin with mineral supplementation (odds ratio = 2.4, 95% confidence interval = 1.3-4.3, P = 0.004) were independently associated with PDA+. Age, gender, preoperative thyroid disease, and comorbidities did not independently predict PDA+. CONCLUSIONS: After thyroidectomy, achieving euthyroidism can take nearly 4 mo. Iron and mineral supplementation are associated with PDA+. This information can inform the preoperative counseling of patients and suggests that this may expedite achieving euthyroidism.


Assuntos
Terapia de Reposição Hormonal/métodos , Hipertireoidismo/induzido quimicamente , Hipotireoidismo/tratamento farmacológico , Tireoidectomia/efeitos adversos , Tiroxina/administração & dosagem , Adulto , Idoso , Suplementos Nutricionais/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/estatística & dados numéricos , Humanos , Hipertireoidismo/sangue , Hipotireoidismo/sangue , Hipotireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Tiroxina/efeitos adversos , Tiroxina/sangue , Fatores de Tempo
13.
Expert Opin Drug Saf ; 18(4): 321-332, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30998433

RESUMO

INTRODUCTION: The cardiovascular (CV) safety of testosterone replacement therapy (TRT) remains a crucial issue in the management of subjects with late-onset hypogonadism. The authors systematically reviewed and discussed the available evidence focusing our analysis on heart-related issues. AREAS COVERED: All the available data from prospective observational studies evaluating the role endogenous T levels on the risk of acute myocardial infarction (AMI) were collected and analyzed. In addition, the impact of TRT on heart-related diseases, as derived from pharmaco-epidemiological studies as well as from randomized placebo-controlled trials (RCTs), was also investigated. EXPERT OPINION: Available evidence indicates that endogenous low T represents a risk factor of AMI incidence and its related mortality. TRT in hypogonadal patients is able to improve angina symptoms in subjects with ischemic heart diseases and exercise ability in patients with heart failure (HF). In addition, when prescribed according to the recommended dosage, TRT does not increase the risk of heart-related events.


Assuntos
Doenças Cardiovasculares/induzido quimicamente , Cardiopatias/induzido quimicamente , Testosterona/administração & dosagem , Animais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Relação Dose-Resposta a Droga , Cardiopatias/epidemiologia , Cardiopatias/fisiopatologia , Terapia de Reposição Hormonal/efeitos adversos , Terapia de Reposição Hormonal/métodos , Humanos , Incidência , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Testosterona/efeitos adversos , Testosterona/metabolismo
15.
Endocrinol Metab Clin North Am ; 48(2): 429-440, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027550

RESUMO

Transgender persons receiving gender-affirming hormone therapy and procedures may face specific skin conditions. Skin diseases in transgender patients often are underdiagnosed and underrecognized despite their important impact on quality of life and mental health. This article discusses pathophysiology, diagnosis, and treatment of common skin diseases in the transgender populations. For transmasculine patients, conditions include acne vulgaris and male pattern hair loss. For transfeminine patients, conditions include hirsutism, pseudofolliculitis barbae, and melasma. Postprocedural keloids and other cutaneous complications are discussed. Unique aspects of skin health in transgender persons should be considered in the context of multidisciplinary gender-affirming care.


Assuntos
Acne Vulgar , Alopecia , Hirsutismo , Terapia de Reposição Hormonal , Queloide , Procedimentos de Readequação Sexual , Pessoas Transgênero , Transexualidade , Acne Vulgar/induzido quimicamente , Acne Vulgar/etiologia , Alopecia/induzido quimicamente , Alopecia/etiologia , Hirsutismo/induzido quimicamente , Hirsutismo/etiologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Queloide/induzido quimicamente , Queloide/etiologia , Procedimentos de Readequação Sexual/efeitos adversos , Transexualidade/tratamento farmacológico , Transexualidade/cirurgia
16.
Acta Biomed ; 90(1): 158-167, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30889170

RESUMO

BACKGROUND: Transfusion-dependent ß-thalassemia (TDT) is associated with several complications necessitating a multidisciplinary approach for diagnosis, treatment and follow-up. Hypogonadism in female TDT patients is one of the most common endocrine complications, requiring hormone replacement therapy (HRT) throughout reproductive life. Little is known about the balance of benefits versus risks of treatment with sex steroids. AIM: The aim of this manuscript is to review the action and the associated adverse effects of HRT in hypogonadal TDT females. DESIGN: Retrospective medical database records from a single centre, over a period of 38 years (January 1980 to June 2018), were reviewed. STUDY POPULATION: Forty-two cases of hypogonadism in TDT females followed in a pediatric and adolescent outpatient clinics, were in included in the study. METHODS: Auxological, clinical, laboratory, hormonal and imaging investigations were reviewed, as well as all adverse events registered during HRT. MAIN RESULTS: In general, HRT was safe for most patients. There were few minor side effects and a couple of rare but serious adverse events. CONCLUSIONS: The study provides a representative clinical profile of long-term effects of HRT in hypogonadal adolescents and young adult TDT women. Our results highlight also the need for further research in other areas for which HRT may have a role.  We hope this will contribute to a wider understanding, and potential improvement, of patient safety and quality of life.


Assuntos
Transfusão de Sangue , Terapia de Reposição Hormonal , Hipogonadismo/tratamento farmacológico , Talassemia beta/complicações , Adolescente , Adulto , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipogonadismo/etiologia , Fenótipo , Estudos Retrospectivos , Adulto Jovem
17.
Post Reprod Health ; 25(1): 33-37, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30773990

RESUMO

In women at population risk of breast cancer (i.e. most), short-term exposure to hormone replacement therapy (i.e. up to five years' use) for symptom relief exceeds its potential harms, including the associated, increased risk of breast cancer diagnosis. Many women and health care professionals, however, consider this to be unacceptably high, although the degree of risk conferred appears equivalent to, or less than that of, other lifestyle risk factors for this condition. In contrast, it is recommended that symptomatic women at high baseline risk due to a family history or a biopsy-confirmed high-risk benign breast condition and those with previous breast cancer should be managed initially with lifestyle changes and non-hormonal alternatives. In a minority, whose symptoms are refractory, hormone replacement therapy and or topical estrogen can be considered but prescription should only take place after a discussion between the patient, her primary health care and breast specialist teams.


Assuntos
Neoplasias da Mama/diagnóstico , Terapia de Reposição Hormonal , Menopausa , Neoplasias da Mama/genética , Consenso , Feminino , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Estilo de Vida , Educação de Pacientes como Assunto , Medição de Risco
18.
Asia Pac J Clin Oncol ; 15(5): e147-e153, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30761745

RESUMO

AIM: There is no consensus regarding the association between hormone replacement therapy (HRT) and risk of meningioma so far. We conducted the first study among Chinese female patients to investigate the influence of HRT use on the risk of meningioma. METHODS: We retrospectively collected records of diagnosis of meningioma for women aged 50 years and above during 2011-2016 and dispense of HRT prior to meningioma diagnosis in three tertiary hospitals in China. Meningioma cases were matched with controls at a ratio of 1:2 by using nearest neighbor propensity scores matching in order to balance the baseline characteristics between groups, which generated a total of 629 cases with 1258 controls. RESULTS: We observed prior use of HRT associated with increased risk of meningioma (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.4) and the association was more prominent among women having multiple HRT dispenses and longer term exposure (OR, 1.3; 95% CI, 1.1-1.6), among those with combination therapy of estrogens and progestogens (OR, 1.3; 95% CI, 1.1-1.7) than monotherapy, and among progestogen users than estrogen users as for monotherapy. Furthermore, vaginal, subcutaneous implant seems to be associated with a higher risk of meningioma compared with oral administration although no significance had been reached. CONCLUSION: This case-control study provides evidence that hormone use for an HRT purpose might constitute the development and growth of meningioma as an independent risk factor, especially for combination therapy and/or long-term users, which supports that meningioma might be a hormone-sensitive tumor.


Assuntos
Terapia de Reposição Hormonal/efeitos adversos , Hospitais/estatística & dados numéricos , Neoplasias Meníngeas/etiologia , Meningioma/etiologia , Pontuação de Propensão , Idoso , Estudos de Casos e Controles , China , Feminino , Humanos , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
19.
J Cosmet Dermatol ; 18(2): 458-463, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30779300

RESUMO

We described-along with a genetic predisposition and exposure to sunlight, as the main factors for melasma development-pregnancy, hormonal therapies, and oral contraceptive pills. Whilst hormonal alteration or therapies are frequently reported in literature in association with melasma, studies analyzing the laboratoristic correlation are limited. We review data published on hormones variations both in women and males with melasma and report some peculiar clinical cases that further demonstrate how the relationship between hormone secretion and melasma development is difficult to be defined.


Assuntos
Estrogênios/metabolismo , Melanose/etiologia , Progesterona/metabolismo , Pigmentação da Pele/fisiologia , Pele/metabolismo , Anticoncepcionais Orais/efeitos adversos , Estrogênios/sangue , Feminino , Predisposição Genética para Doença , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Masculino , Melanose/sangue , Gravidez , Progesterona/sangue , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Fatores de Risco , Pele/efeitos dos fármacos , Pele/efeitos da radiação , Pigmentação da Pele/efeitos dos fármacos , Luz Solar/efeitos adversos
20.
Trials ; 20(1): 143, 2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30782213

RESUMO

BACKGROUND: Subclinical hypothyroidism is a common condition in patients with heart failure and is defined as elevated serum thyroid hormone (TSH) with normal circulating free thyroxine (FT4). Evidence on the effect of thyroid hormone treatment is lacking. We designed a randomized controlled trial to compare the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism. METHODS/DESIGN: Eligible participants were identified from the cardiology units of five study centers based on the following criteria: 18 years or older, systolic heart failure with NewYork Heart Association (NYHA) class II-III, left ventricular ejection fraction ≤ 40%, and subclinical hypothyroidism (TSH > 4.78µIU/ml, < 10 µIU/ml + FT4 level within reference range). Eligible patients will be randomly assigned in a 1:1 manner to receive thyroxine replacement therapy plus standard chronic heart failure (CHF) treatment or only standard CHF therapy. Levothyroxine will be administered at an initial dose of 12.5 µg once daily and will be titrated until TSH is within the normal range. The primary endpoints include the difference in distance of the six-minute walk test between 24 weeks and baseline. The secondary endpoints include differences in plasma NT-proBNP levels and serum lipid profiles, changes in the NYHA classification, cardiovascular death, re-hospitalization, differences in echocardiographic and cardiac magnetic resonance imaging measures, and Minnesota Living With Heart Failure Questionnaire (MLHFQ) results between 24 weeks and baseline. DISCUSSION: ThyroHeart-CHF is designed as a prospective, multi-center, randomized, controlled clinical trial to study the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism. The study findings will have significant implications for discovering the new therapeutic targets and methods of heart failure. TRAIL REGISTRATION: ClinicalTrials.gov, NCT03096613 . Registered on 30 March 2017.


Assuntos
Tolerância ao Exercício/efeitos dos fármacos , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Hipotireoidismo/tratamento farmacológico , Tiroxina/uso terapêutico , Doenças Assintomáticas , China , Doença Crônica , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/diagnóstico , Insuficiência Cardíaca Sistólica/fisiopatologia , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Hipotireoidismo/fisiopatologia , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tiroxina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos , Teste de Caminhada
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