Measurement of bone mineral density (BMD) with quantitative computed tomography (QCT) in postmenopausal osteoporosis: effect of estrogen.

UNLABELLED: To determine the efficacy of the estrogen replacement therapy (ERT) on the bone mineral density (BMD) measured with quantitative computed tomography (QCT) in postmenopausal osteoporosis 16 women aged 46-72 were examined. They were divided into two groups: 8 women treated with conjugated estrogens (Group I) and 8 who did not received ERT (Group II). In all 16 patients the serum hormonal concentrations (LH, FSH and estradiol) were measured with radioimmunological methods. The bone densitometry was performed in all of them using the single-energy computed tomography (QCT) with the computer Picker 1200. Bone mineral density was measured in three lumbar vertebra (L1-L3) and expressed in milligrams K2HPO4 per ml. The bone mineral density (BMD) was statistically significantly higher in the estrogen treated group (Group I) in every vertebra compared with that of controls (Group II). The serum FSH concentration was statistically significantly lower in the ERT group (Group I) and a statistically significant correlation between FSH level and average BMD (Lmean) was present. IN CONCLUSION: 1. the ERT is very efficacious in preventing bone loss in postmenopausal women; 2. measurement of BMD in lumbar vertebra L1 or L3 may be a sufficiently reliable and accurate, cost-effective and time-saving method of screening for osteoporosis; 3. the serum FSH determination seems to be useful in monitoring of the estrogen therapy for postmenopausal osteoporosis.

[Evaluation of danazol treatment of women with fibrocystic disease of breast]. / Ocena leczenia danazolem kobiet z wlóknisto-torbielkowym zwyrodnieniem sutka.

The results of treatment of 20 female patients with fibrocystic degeneration of the breast with danazol are discussed. Diagnosis was made with the aid of mammography. Danazol was administered in the dose of 200 mg twice a day for 2 months, followed by 100 mg thrice a day, and 100 mg twice a day for further 2 months. An improvement in the clinical symptoms, decrease in LH, FSH, estradiol and progesterone levels was produced by danazol. The drug did not change LH response to LH-RH stimulation while blockade of dopaminergic receptors with metoclopramide decreased PRL response.

Natural killer cell activity and sex hormone levels in mastopathy.

The aim of the study was to test the cytotoxic activity of peripheral blood natural killer (NK) cells in relation to serum levels of sex hormones in patients with mastopathy. The study included 37 patients classified into mastalgia, fibrosis, fibrocystic disease, and fibroadenoma groups and 19 healthy age-matched volunteer women. Estradiol, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin were evaluated in sera by specific radioimmunoassays. NK cell activity was evaluated by means of 51Cr-release assay. In all patient groups, progesterone levels were significantly decreased. There was also an increased frequency of patients with low levels of estradiol (< 50 pg/ml). On the other hand, LH levels in fibrocystic disease and fibroadenoma groups were significantly increased. NK cell activity was in the normal range in all patient groups. In individual women, NK cell cytotoxicity did not correlate with the levels of the studied hormones. However, in patients with low (< 50 pg/ml) and high (> 200 pg/ml) estradiol levels an increase and a decrease of NK cell activity was observed, respectively. This suggests that in patients with mastopathy, estradiol may directly or indirectly affect NK cell cytotoxicity. High levels of estradiol and low NK cell activity might constitute an increased risk for neoplasia.

Transdermal 17 beta-estradiol combined with oral progestogen increases plasma levels of insulin-like growth factor-I in postmenopausal women.

In order to evaluate the effect of postmenopausal estrogen replacement therapy on the plasma levels of the insulin-like growth factor-I (IGF-I) 12 postmenopausal women aged 44 to 59 years were studied. The control group consisted of 15 healthy premenopausal women aged 20-44 years. In the postmenopausal women the plasma levels of IGF-I, gonadotrophins and sex hormones were determined before and after 3 and 6 months cyclic replacement therapy with transdermal 17 beta-estradiol (E2 100 micrograms patches applied twice weekly) combined with oral chlormadinone acetate (2 mg daily for 7 days in each cycle). Basal levels of estradiol (E2), IGF-I, dehydroepiandrosterone sulphate (DHEA-S), testosterone and androstenedione were lower, but gonadotropin levels were higher in postmenopausal than in premenopausal women. In all the women studied age was inversely correlated with IGF-I levels (r = -0.793, p less than 0.001) and with DHEA-S concentrations (r = -0.435, p less than 0.02). In postmenopausal women transdermal estradiol administration restored the circulating E2 levels to the early follicular range and increased the IGF-I levels (from 76.4 +/- 9.2 micrograms/l to 141.8 +/- 20.8 micrograms/l; p less than 0.01). Transdermal estradiol decreased gonadotrophin levels without changes in concentration of DHEA-S, testosterone, androstenedione and SHBG. In postmenopausal women before and during replacement therapy a positive correlation was found between estradiol and IGF-I concentrations (r = -0.439, p less than 0.01). These results suggest that cyclic replacement therapy with transdermal 17 beta-estradiol in combination with chlormadinone acetate given orally increase the plasma levels of IGF-I in postmenopausal women.

Two pregnancies in a woman with Cushing's syndrome treated with cyproheptadine. Case report.

A young woman with Cushing's syndrome who had had amenorrhoea for six years was treated with cyproheptadine and became pregnant five months later. Treatment with cyproheptadine was continued till six weeks after delivery by which time all the features of Cushing's syndrome had disappeared. The baby developed normally but died of gastroenteritis when four months old. Two years later the patient became pregnant again without further treatment. Pregnancy and labour were uncomplicated and mother and son did well. A full remission of Cushing's syndrome was confirmed two months after delivery.

Effects of transdermal 17 beta-oestradiol combined with oral progestogen on lipids and lipoproteins in hypercholesterolaemic postmenopausal women.

OBJECTIVES: The purpose of the study was to evaluate the effect of transdermal 17 beta-oestradiol with oral progestogen on the plasma levels of lipids, lipoproteins and apolipoproteins in hypercholesterolaemic postmenopausal women. DESIGN: During 6 months of replacement therapy with transdermal 17 beta-oestradiol combined with oral progestogen, plasma lipids, lipoproteins and apolipoproteins after 3 and 6 months were measured and compared with pretreatment values by Student's t-test. SETTING: From January 1992 until September 1992 patients were diagnosed and treated in an out-patient clinic of the Department of Endocrinology Medical Centre for Postgraduate Education, Warsaw. SUBJECTS: The patients studied were 11 non-obese postmenopausal women with hypercholesterolaemia based on the World Health Organization criteria. INTERVENTIONS: Venous blood samples were obtained before and 3 and 6 months after the beginning of cyclic replacement therapy with transdermal 17 beta-oestradiol (E2 100 micrograms day-1 combined with oral chlormadinone acetate (2 mg day-1 for 7 days in each cycle). MAIN OUTCOME MEASURES: The antiatherogenic effect of transdermal oestrogen replacement therapy exerted by increased levels of high-density lipoprotein subfraction 2 cholesterol (HDL2-C) leading to the decrease of the total cholesterol level was anticipated. RESULTS: After 6 months of the treatment the concentrations of HDL2 cholesterol (HDL2-C) increased from 0.45 +/- 0.07 mmol l-1 to 0.73 +/- 0.03 mol l-1 (P < 0.05) but the levels of HDL3 cholesterol (HDL3-C) decreased from 1.15 +/- 0.06 mmol l-1 to 0.89 +/- 0.07 mmol l-1 (P < 0.05). The concentrations of total cholesterol decreased from 6.9 +/- 0.13 mmol l-1 to 6.2 +/- 0.2 mmol l-1 (P < 0.05). No changes were observed in the plasma levels of total triglycerides, HDL cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, VLDL triglycerides, apolipoproteins A-I and B. CONCLUSIONS: In hypercholesterolaemic postmenopausal women, transdermally administered 17 beta-oestradiol 100 micrograms daily in combination with oral chlormadinone acetate has a beneficial effect through raising the level of the antiatherogenic HDL2-C subfraction and decreasing the level of total cholesterol.

The role of hyperinsulinemia in the development of lipid disturbances in nonobese and obese women with the polycystic ovary syndrome.

In order to establish the role of insulin in the pathogenesis of lipid abnormalities in hyperandrogenic women with the polycystic ovary syndrome (PCO) 49 women aged 18 to 35 yr with a normal glucose tolerance test were studied. They were divided into two groups: 27 women with PCO (9 obese and 18 nonobese), and 22 healthy women (12 with simple obesity and 10 with normal body weight). In the PCO group, the fasting insulin levels and the insulin response to oral glucose load were higher than in the matched controls. Significantly lower levels of HDL2-cholesterol and higher levels of apolipoprotein B were observed in obese and non nonobese PCO patients. In obese women with PCO this was associated with lower levels of HDL-cholesterol and apolipoprotein A-I (Apo A-I), whereas the levels of total triglycerides and VLDL-triglycerides (VLDL-TG) were increased. Multiple regression analysis in PCO women, after adjustment for age, body mass index and the levels of insulin and sex hormones, showed a strong positive correlation between the fasting insulin levels and total triglycerides and VLDL-TG, while a negative correlation was found between fasting insulin levels and apo A-I. These results indicate that hyperinsulinemia may play a role in the development of lipid disturbances in women with the PCO.