Anti-goat antibodies as a rare cause of high gonadotropin levels during menopausal transition

Abstract

Objective: To understand the origin of extremely high gonadotropin levels in a perimenopausal woman.

Methods: A 52-year-old woman with a 2?months of amenorrhea followed spontaneous menstrual cycles recovery was referred to our outpatient clinic with elevated follicle-stimulating hormone (FSH, 483 mUI/ml), luteinizing hormone (LH, 475 mUI/ml) and prolactin (PRL, 173?ng/ml). She was known to take levosulpiride. The gonadotropin levels did not fit with the clinical features.

Results: A gonadotroph tumor was ruled out. Further analysis confirmed constantly high FSH, LH and PRL levels. The measurements were repeated using different analytical platforms with different results. After serial dilutions, nonlinearity was present suggesting an immunoassay interference. After post-polyethylene glycol recovery, hormone levels appeared in the normal range. Anti-goat antibodies were recognized in the serum of the patient.

Conclusions: This case report shows a case of falsely abnormal high gonadotropin and PRL levels in a woman during menopause transition. In the clinical practice the evaluation of gonadotropin profile is not recommended at this age, but the abnormal levels stimulated further evaluation. An interference in the assay due to anti-goat antibodies resulted in abnormally high level of FSH and LH. A strict collaboration between clinicians and the laboratory is needed, when laboratory findings do not correspond to clinical findings.     

Prevention of early postmenopausal bone loss using low doses of conjugated estrogens and the non-hormonal,bone-active drug ipriflavone

Hormone replacement therapy is the optimal therapeutic choice for postmenopausal syndrome. While low doses of estrogens (0.3 mg/day of conjugated estrogens) can counteract neurovegetative menopausal symptoms, higher doses (0.625 mg/day of conjugated estrogens) are required to prevent bone loss in postmenopausal women. Experimental and clinical studies have shown that ipriflavone, a non-hormonal isoflavone derivative, is effective in the prevention and treatment of postmenopausal osteoporosis. The aim of the present investigation was to evaluate the efficacy and toler-ability of ipriflavone and very low doses of equine conjugated estrogens on bone loss in early postmenopausal women. Eighty-three healthy postmenopausal women (50.3±0.7 years) were enrolled for this 1-year multicenter study. All subjects were randomly allocated to receive: double placebo (n=24; group A), placebo plus conjugated equine estrogens 0.30 mg/day (n=31; group B) or conjugated equine estrogens 0.30 mg/day plus oral ipriflavone 200 mg tris in die at meals (n=28; group C), according to a double-masked design. Among women who completed the treatment period (valid completers), those of group A showed a progressive decrease in forearm bone density (FBD; measured by dual photon absorptiometry) that reached 1.7% after 12 months. The women in group B maintained their FBD in the first 6 months of treatment but, at the end of the study, showed a bone loss of 1.4% compared with basal values. By contrast, women in group C showed a significant increase in FBD after 1 year of treatment (+5.6%;p<0.01). Bothvalid completers andintention to treat analyses revealed a significant difference (p<0.05) between group A and group C over the study period. None of the treatments produced significant changes of biochemical markers of bone turnover, while hot flushes and other climacteric symptoms were significantly reduced after the sixth month of treatment in women receiving estrogens. Adverse events were generally mild, and did not differ among the groups. The results of this study suggest that low doses of estrogens combined with ipriflavone could represent a new therapeutic approach to the treatment of the postmenopausal syndrome.     

Efficacy and tolerability of estraderm MX, a new estradiol matrix patch

Objectives: To assess the efficacy and tolerability of a new matrix patch delivering 0.05 mg estradiol per day (Estraderm MX 50) in postmenopausal women with moderate to severe postmenopausal symptoms. Methods: A multicenter, double-blin, randomized, between-patient, placebo controlled trial in 109 postmenopausal women was carried out. Patches were applied twice weekly for 12 weeks. Patients were assessed at 4, 8 and 12 weeks of treatment. The primary efficacy variable was change from baseline in mean number of moderate to severe hot flushes (including night sweats) per 24 h during the last 2 weeks of treatment. Other variables included Kupperman Index, local and systemic tolerability. Plasma concentrations of estradiol (E2), estrone (E1) and estrone sulfate (E1S) were determined before and after treatment. Results: Estraderm MX was significantly superior to placebo (P < 0.001) in reducing mean number of moderate to severe hot flushes (including night sweats) per 24 h after 4, 8 and 12 weeks of treatment. The estimate of treatment group differences after 12 weeks was 4.2 hot flushes (95% confidence interval: 2.6–5.5). Estraderm MX also significantly reduced Kupperman Index at all time points compared to placebo (P < 0.001). Estraderm MX induced increases in mean E2, E1 and E1S plasma levels as expected (E2: baseline 2.7 pg/ml, 12 weeks 38.9 pg/ml; E1: baseline 18.8 pg/ml, 12 weeks 41.6 pg/ml; E1S: baseline 235.6 pg/ml, 12 weeks 765.1 pg/ml). Overall rates of adverse experiences were similar for Estraderm MX and placebo. The number of patients reporting skin irritation was low and similar in both groups. Conclusions: Estraderm MX 50, a new matrix patch, offers an effective and well tolerated dosage form for transdermal delivery of 0.05 mg E2 per day.     

The effect of tibolone versus continuous combined norethisterone acetate and oestradiol on memory, libido and mood of postmenopausal women: a pilot study

Objective: Several studies have shown a positive effect of oestrogen on memory, mood and well-being but these data are controversial and focus particularly on the effect of oestrogen alone. In this pilot study we have investigated the effect of a continuous combination of norethisterone acetate 1 mg and oestradiol valerate 2 mg (Kliogest®) versus tibolone (Livial®) on memory, sexuality and mood. Methods: Twenty-two postmenopausal women, age range 51–57, were randomised to a 6 months single blind interventional study treatment with either continuous combined oestradiol plus norethisterone acetate, or tibolone. Computerised psychological test of memory, mood and libido were administered both before and at the end of the 6 months treatment. Results: Fourteen patients completed the study; eight on Livial® and six on Kliogest®. Recognition memory was improved by Kliogest but not by Livial (P<0.05) while either drug equally improved both the reaction time (P<0.01) and accuracy of performance (P<0.001) of categorical semantic memory. Both the treatments improved libido significantly (P<0.05), while the mood did not change with either. Conclusion: The results suggest that both these forms of hormonal replacement therapy improve the efficiency of memory performance and libido. However, a combination of oestradiol and norethisterone acetate seems to be marginally more effective on improving cognitive processes.     

200例更年期综合征妇女精神心理及社会因素现况调查

目的：了解更年期综合征患者精神和心理障碍,探讨社会因素对其的影响,方法：通过问卷式表格填写的方法,对200例更年期综合征妇女进行进行躯体表现、精神和心理障碍,应激反应、性生活、应激事件等现况调查,结果：更年期货征妇女普遍存在精神心理障碍,65％应激反应下降,50％性功能下降,生活中应激事件与更年期的综合征互为影响,结论：提高这一人群的生命质量,激素替代治疗须配合心理支持治疗。     

药食两用中药复方对去卵巢大鼠内分泌激素的影响

目的：探讨药食两用中药复方治疗绝经期综合征的作用机理。方法：以去卵巢大鼠为动物模型，已烯雌酚片为阳性对照药物，采用放射免疫测定法观察该复方对血清E2，FSH，LH，T，P，T3，T4及TSH等激素水平的影响。结果：与去卵巢空白对照组比较，该中药复方能升高血清E2值，降低血清FSH，LH，T3，T4值，差异均有显著性（P〈0．05）。结论：该中药复方能多途径调节卵巢大鼠生殖内分泌功能，改善甲状腺功能。提示其能够稳定机体内环境，缓解绝经期综合征症状。     

绝经期抑郁症3种治疗方案的比较

目的:探讨氟西汀联合结合雌激素加甲羟孕酮(倍美盈),治疗绝经期抑郁症的疗效。方法:将106例绝经期抑郁症的妇女随机分3组。合用组39例:每日口服倍美盈和氟西汀各1粒:氟西汀组36例:每日口服氟西汀1粒;激素补充治疗(HRT)组31例:每日口服倍美盈1粒。疗程均8周。采用Ham ilton抑郁量表(HAMD)评价抑郁严重程度,采用Kupper-m an评分指数(KM l)评价绝经期症状。结果:治疗前后合用组、氟西汀组、HRT组HAMD总分分别为(23.01±3.54)、(4.98±4.48),(23.02±4.38)、(6.97±5.44),(23.04±4.56)、(10.01±5.75)。治疗后与治疗前比较3组总分均下降,差异有非常显著性(P<0.01)。治疗前后合用组、氟西汀组、HRT组KM I评分指数分别为(32.10±7.42)、(7.57±4.64),(31.83±7.65)、(16.09±6.06),(32.01±7.29)、(9.70±7.02),治疗后与治疗前比较3组总分均下降,差异有非常显著性(P<0.001)。但合用组和HRT组与氟西汀组比较减分率更高,差异有非常显著性(P<0.01)。结论:合用氟西汀和倍美盈治疗发生于绝经期的抑郁症,可以显著提高对抑郁症状的疗效。     

激素治疗对绝经妇女子宫肌瘤的影响

目的:观察个体化周期序贯激素治疗对绝经妇女子宫肌瘤发生及生长的影响。方法:选择因绝经相关症状且合并单发性子宫肌瘤(肌瘤最大径线<5 cm)的绝经妇女60例,给予雌孕激素周期序贯方案,起始剂量为口服戊酸雌二醇1.0 mg,每日1次,连用21~25天,后10~14天加用甲羟孕酮每日4 mg。随后,根据每人对药物的不同反应,调整口服戊酸雌二醇的每日用量为0.5~2.0 mg,甲羟孕酮的每日用量相应为4~6 mg。不能连续应用激素治疗或失访者被排除。分别于治疗前及治疗3、6、122、43、6个月时采用阴道超声测定肌瘤大小及子宫内膜厚度。结果:53例患者完成了3年的观察,平均年龄51.4(44~57)岁,绝经年限平均2.3(1~7)年。激素周期序贯治疗3、6、12、24、36个月,肌瘤大小均无明显改变(P>0.05),没发现新生肌瘤(P>0.05),子宫内膜厚度均无明显增厚(P>0.05)。结论:根据个体对药物反应不同制定不同剂量的激素周期序贯方案,不促进绝经妇女子宫肌瘤的发生和生长。     

希明婷联合雌激素治疗绝经期综合征的临床观察

目的观察希明婷联合雌激素对围绝经期综合征改善的影响。方法随机抽取围绝经期患者90例,分为希明婷、雌激素、联合用药组,分别服用希明婷、尼尔雌醇、联合用药6个月,观察药物对症状的改善程度及对卵泡刺激素、黄体生成素、雌二醇的影响。结果3组均可明显改善症状(P<0.01),后两组能提高血清激素水平(P<0.01),且联合用药组优于雌激素组(P<0.01)。结论希明婷联合雌激素治疗可以明显改善围绝经期综合征症状,有望成为更有效的治疗药物。     

阳和汤治疗更年期尿道综合征疗效及对患者排尿情况和性激素水平的影响

目的:观察阳和汤治疗更年期尿道综合征及对患者排尿情况和性激素水平的影响.方法:选取更年期尿道综合征患者180例,分为两组,每组90例.对照组给予尼尔雌醇治疗,观察组给予阳和汤联合尼尔雌醇治疗.记录两组症状评分、排尿情况及性激素变化,并统计两组总有效率.结果:治疗前后组内比较发现,两组尿频、尿急、排尿不畅及耻骨上不适评分...