Granulosa cell tumor associated with secondary amenorrhea and serum luteinizing hormone elevation

Adult granulosa cell tumors (GCTs) are the most common type of ovarian sex cord tumors. Menstrual irregularity, menorrhagia, or even secondary amenorrhea is frequently observed in premenopausal women bearing GCTs with hormonal activity. We report herein a case of GCT in a patient presenting with secondary amenorrhea and serum luteinizing hormone elevation. A 28-year-old primigravid Japanese woman was admitted complaining of secondary amenorrhea of 2 years' duration. Pelvic examination, transvaginal ultrasonography, and magnetic resonance imaging demonstrated a left ovarian tumor 4 cm in diameter. Serum hormone assays revealed a follicle-stimulating hormone level of 4.8 mIU/ml, luteinizing hormone (LH) of 35.8 mIU/ml, estradiol of 24 pg/ml, progesterone of 1.6 ng/ml, and testosterone of 40 ng/dl. A left salpingo-oophorectomy was performed. The tumor was diagnosed as an adult-type GCT stage IIb (FIGO [International Federation of Obstetricians and Gynecologists], 1988). Spontaneous menstruation occurred soon after the surgery. Serum levels of LH also decreased to normal levels and showed cyclic changes during the menstrual cycle. Subsequently, the patient conceived and delivered a healthy female baby. The tumor recurred in the pelvis 50 months after the initial conservative surgery, with elevated serum LH levels of 36.0 mIU/ml and amenorrhea. The patient was treated by hysterectomy, right salpingo-oophorectomy, omentectomy, paraaortic and pelvic lymphadenectomy, and low anterior resection of the recto-sigmoid colon. Her hormone levels progressed to the postmenopausal state after this surgery. Although LH elevation in patients with GCT is rare and its mechanism is unknown, monitoring of serum LH may provide an additional tumor marker after conservative surgery in such patients.     

Irinotecan HCl, an anticancer topoisomerase I inhibitor, frequently induces ovarian failure in premenopausal and perimenopausal women

The effects of irinotecan HCl (CPT-11) combination chemotherapies on the hypothalamus-pituitary-ovary endocrine system were examined clinically. The incidences of typical menopausal malaises and/or endocrinological findings were investigated in 32 gynecological cancer patients treated by CPT-11 combination chemotherapies. Patients who complained of menopausal malaises or had been treated by hormone replacement therapy before chemotherapy were excluded from the study. Menopausal malaise-like symptoms (MMLS) appeared in 6 of 32 patients (18.8%) during CPT-11 combination chemotherapy, and these symptoms were completely cured within a few days by administration of conjugated estrogen tablets (0.625 mg/day). All the MMLS cases were perimenopausal patients (47-57 years of age), and MMLS were not found in any of the postmenopausal patients who had exceeded 3 years since endocrinological menopause or patients who had recurrent cancer after pelvic radiotherapy. After exclusion of these 3-year-postmenopausal patients and postirradiation patients, 6 of 7 patients aged 45-59 years complained of MMLS during CPT-11 combination chemotherapy. The incidence of CPT-11-induced MMLS showed no relationships with the anticancer drugs combined with CPT-11, mean total CPT-11 dose, mean number of CPT-11 injections, mean individual CPT-11 dose, grade of CPT-11-specific diarrhea or anticancer effects of each CPT-11 combination chemotherapy. The perimenopausal cancer patients with CPT-11-induced MMLS showed decreased serum estradiol and increased serum FSH and LH levels accompanying the CPT-11 injections. A young patient with CPT-11-induced secondary amenorrhea showed decreased serum estradiol and increased serum FSH and LH levels accompanying the CPT-11 injections. None of the postmenopausal patients with high FSH and LH levels showed any significant differences in their serum FSH, LH, PRL and TSH levels during CPT-11 combination chemotherapy. No differences in the results of LHRH and TRH tests during chemotherapy were found for postmenopausal patients. Histopathological examinations of normal ovarian tissues surgically removed from 4 young cervical cancer patients treated with preoperative CPT-11 combination chemotherapies revealed no growing ovarian follicles in the ovarian tissues. CPT-11 injections can induce estrogen-rescued MMLS in cancer patients aged approximately 50 years at a very high rate and may induce secondary amenorrhea in young women. The endocrinological and histopathological studies revealed that CPT-11 causes ovarian follicular loss and ovarian failure within a short time without affecting hypothalamic and pituitary hormone secretion. These clinical results indicate that CPT-11 has strong ovarian toxicity and that repeated CPT-11 administrations may frequently induce ovarian follicular loss and premature ovarian failure, even in young women.     

乳腺癌患者血清雌二醇、卵泡刺激素及黄体生成素检测结果分析：西门子吖啶酯化学发光法检测报告

目的分析符合NCCN指南绝经标准和正常月经状态的两组乳腺癌患者雌二醇（E2）、卵泡刺激素（FSH）和黄体生成素（LH）3项性激素的水平,为判断60岁以下、未接受卵巢去势但已停经的妇女是否达到绝经状态提供依据,以便合理应用芳香化酶抑制剂。方法前瞻性研究本院用西门子吖啶酯化学发光法检测的204例年龄≥60岁或双侧卵巢切除后的患者（绝经组）,以及128例处于正常月经状态患者（未绝经组）的性激素检测结果。采用核密度图描述3种激素在绝经和未绝经患者的分布特点,用百分位数表分别描述这两组患者的3项性激素数据。两组间3项性激素水平的比较采用Wilcoxon检验。结果绝经组中,E2最高值为53．63pg/ml,FSH和IM的最低值分别为9．68mU／rnl和1.18mU／ml。核密度图显示3项性激素水平都呈偏态分布,它们在绝经和未绝经患者间的差别均有统计学意义（P值均〈0．01）。绝经和未绝经患者3项性激素的分布都有重叠,尤以LH为著。结论LH不宜用于判断乳腺癌患者的绝经状态。对符合2011年中国抗癌协会乳腺癌专业委员会绝经标准专家共识的患者,当西门子吖啶酯化学发光法检测E2〈50pg／ml、FSH〉10mU／ml时,可初步判定其为绝经状态,并可考虑应用AIs,但应追踪性激素的变化,以便及时发现误判的患者。     

Prolactin and pituitary gonadotropin values and responses to acute luteinizing hormone-releasing hormone (LHRH) challenge in patients having long-term treatment with a depot LHRH analogue.

Sixty patients with advanced prostatic carcinoma were treated with monthly subcutaneous injections of a depot formulation of goserelin, a luteinizing hormone-releasing hormone (LHRH) analogue (Zoladex, ICI Pharma, Destelbergen, Belgium). All patients were regularly evaluated with measurements of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and prolactin (PRL) levels. In 15 patients among them who could be treated for more than 42 months, an LHRH stimulation test was performed at the end of each 28-day period and before the next administration of the depot formulation. A complete and maintained suppression of both T and LH levels was seen. FSH levels also decreased, but to a lesser extent than LH levels, and showed a small escape after reaching a minimum value after 1 month of therapy. The LHRH challenge after 42 months of therapy elicited no significant responses of LH and FSH levels. The PRL values showed a small decrease.     

绝经后乳腺癌雌、孕激素受体状态与血清性激素水平的关系

目的探讨绝经后乳腺癌雌激素受体(ER)、孕激素受体(PR)状态与患者血清性激素水平的关系及意义。方法使用全自动免疫分析仪化学发光分析法检测41例乳腺癌患者血清性激素六项(LH、FSH、PRL、E2、P、T)水平,免疫组化EnVision二步法检测乳腺癌ER、PR表达状态。结果绝经后乳腺癌PR阴性组与PR阳性组比较,患者血清LH、FSH水平显著增高(P值分别为0.005和0.031),PRL、E2、P、T水平在二组间差异无统计学意义;在ER阴性组与ER阳性组之间所测性激素水平差异无统计学意义。结论绝经后乳腺癌PR表达状态可能与垂体激素LH、FSH水平有关。     

腹腔镜卵巢移位对年轻中晚期宫颈鳞癌患者同步放化疗后卵巢功能的影响

目的:研究腹腔镜卵巢移位对年轻中晚期宫颈癌同步放化疗后卵巢功能的影响。方法:对我院2012至2016年年轻中晚期宫颈癌进行同步放化疗的患者进行对照研究,将患者分为手术组和对照组,比较两组患者身高、体重、体重指数、术前血清促卵泡成熟激素（FSH）、黄体生成激素（LH）和雌二醇（E2）水平。首次放化疗后3、6、12个月检查患者血清中FSH、LH、E2以及Kupperman评分,比较两组患者的差异。结果:经筛选后共47例患者纳入研究,其中手术组20例,对照组27例。两组患者术前各项参数均无差异（P＞0.05）。治疗后3个月两组患者各项指标均无差异（P＞0.05）。治疗后6个月和12个月手术组患者血清FSH低于对照组（P＜0.05）,E2高于对照组（P＜0.05）,Kupperman评分低于对照组（P＜0.05）。治疗后12个月手术组患者血清LH水平低于对照组（P＜0.05）。结论:腹腔镜卵巢移位术对年轻中晚期宫颈癌同步放化疗后卵巢功能的保护具有积极作用。     

Hypothalamic-pituitary-ovarian axis in women with operable breast cancer treated with adjuvant CMF and tamoxifen

The effect of adjuvant CMF (cyclophosphamide, methotrexate, and 5-fluorouracil) and tamoxifen (TM) on hypothalamic-pituitary-ovarian function was studied in 120 women with stage I-II operable breast cancer. Sixty patients were premenopausal, of whom 25 were treated with CMF for 9 cycles, 25 with CMF for 9 cycles + TM for 2 years, started concurrently, and 10 with TM alone for 2 years. Sixty patients were postmenopausal and they were all treated with TM alone for 2 years. In all groups treatment was started within 4 weeks of mastectomy. Plasma levels of estrone (E1), estradiol-17 beta (E2), follicle-stimulating hormone, luteinizing hormone (LH), prolactin (Prl), testosterone (T) and thyroid-stimulating hormone (TSH) were determined in all patients before surgery and again at 3-month intervals from initiation of the adjuvant therapy. In ten patients of each treatment group FSH-LH and Prl-TSH release was determined following stimulation with releasing hormones. CMF and CMF+TM therapy resulted in amenorrhea in 42/50 premenopausal patients with decrease of E1+E2 (p less than 0.001) and elevation of FSH (p less than 0.001) and LH (p less than 0.01) plasma concentration to postmenopausal levels. In premenopausal women treated with TM a marked increase of E1+E2 (p less than 0.001) was observed with unaltered FSH-LH plasma concentration. A significant fall of Prl also occurred in these patients. In postmenopausal women and premenopausal patients with CMF-induced amenorrhea TM produced a marked fall of FSH-LH and a decrease of Prl plasma level. Plasma TSH and T were not affected in any patient by any of the treatment regimens. The results of the stimulatory tests are in agreement with the hormonal changes observed under basal conditions and indicate that, whereas CMF suppresses the ovary and does not alter hypothalamic-pituitary function, TM induces profound changes of the hypothalamic-pituitary-ovarian axis.     

Endocrine profile in breast cancer patients receiving chemotherapy.

Cyclophosphamide and other alkylating agents suppress ovarian function in pre-menopausal women. However, endocrine details remain unknown regarding the influence of patients' age and obesity on CMF-induced hormonal changes. We studied changes in endocrine profile due to chemotherapy (CMF) in 70 pre-menopausal patients with axillary node positive, stage II and/or III breast carcinoma. Plasma levels of estrone (E1), estradiol (E2), androstenedione (A2), luteinizing hormone (LH), and prolactin (PRL) were determined on day 1 and 8 of each chemocycle for 12 cycles. After receiving therapy, 23% of the women continued to have regular menstrual cycles (non-amenorrheic group). In the remaining 77%, ovarian function was suppressed, as evidenced by the onset of amenorrhea within 0-11 months (amenorrheic group). The mean time to amenorrhea was 2.83 +/- 0.33 months (SE). The time required to develop amenorrhea inversely correlated to the patient's age. Both incidence of amenorrhea and time to amenorrhea remained unaffected by either patient's obesity or the timing of chemotherapy initiation in relation to menstrual cycle phase (progestational, follicular). Plasma hormone levels fluctuated widely in both groups during the first three chemocycles. During chemocycle months 4 to 10, in the amenorrheic group, plasma E1, E2, and P declined to their baseline levels with a concomitant rise in LH levels. At this time, E1, E2, and P levels were significantly lower in amenorrheics, despite menstrual cycle associated fluctuations in the non-amenorrheic group. Estrogens (E1 and E2) gradually declined further following the onset of amenorrhea in subsequent months. Further data analysis suggests that host age or obesity did not influence CMF-induced changes in the plasma endocrine profile.     

Effect of combination chemotherapy on pituitary-gonadal function in patients with lymphoma and leukemia

After at least four courses of intermittent chemotherapy, 14 of the 15 men with malignant lymphoma had elevated serum follicle-stimulating hormone (FSH). In three of these subjects, serial studies showed progressive increases in basal FSH and exaggerated FSH responses to luteinizing hormone releasing hormone (LHRH). Although gonadal biopsies were not done, this elevation of FSH is indicative of progressive and severe damage to the germinal epithelium by chemotherapy. Elevated leutinizing hormone (LH) was found in seven and decreased testosterone (T) in two of these subjects. Increased LH responses to LHRH stimulation were also found in the three subjects studied. These findings suggest that the testicular damage is not restricted to the germinal tissue. In four male subjects with acute myeloid leukemia treated by intermittent chemotherapy not containing any alkylating agents, FSH, LH, and T levels were normal. Three of the 4 female patients with malignant lymphoma and two with acute myeloid leukemia had normal basal, serial, and LHRH-stimulated FSH, LH, and estradiol (E2) levels. Elevated gonadotropins and low E2 were found only in subjects who had received abdominal irradiation.     

The role of ovarian ablation in the adjuvant therapy of breast cancer

Increasing interest has emerged in the role of ovarian function suppression, which has shown equivalence to adjuvant CMF (cyclophosphamide, methotrexate, 5-fluorouracil), whether achieved by surgery or irradiation, in breast cancer patients. Studies have suggested temporary amenorrhea can confer benefit in early breast cancer, giving luteinizing hormone-releasing hormone (LH-RH) agonists an advantage over oophorectomy or radiation. Compared with no therapy, LH-RH agonists reduce risks of recurrence and death among women younger than 50 years of age who have hormone receptor-positive tumors. Trials are assessing the benefits of adding LH-RH agonists to aromatase inhibitors, tamoxifen, or after chemotherapy in women remaining premenopausal, and the necessity for adjuvant chemotherapy with combined ovarian ablation and antiestrogen therapy.     

胃癌、大肠癌患者血清性激素水平测定的临床意义

目的：探讨胃肠癌患者血清性激素水平及其临床意义。方法：采用放射免疫法，测定116例胃肠癌患者血清黄体生成素（LH），卵泡刺激素（FSH），催乳素（PRL），睾酮（T）及雌二醇（E2）水平。结果：胃癌患者LH，FSH，PRL水平均高于对照组（P＞0．05），T，E2水平均低于对照组，男性胃癌患者T水平显著低于对照组（P＜0．05），年龄小于60岁的男性胃癌患者血清T水平随肿瘤恶性程度的增加而明显下降（P＜0．01），结直肠癌患者TH，FSH，PRL，T水平与正常人比较，无显著性差异（P＞0．05），男性患者血清E2水平在正常值范围，女性患者E2水平显著低于正常人（P＜0．05），并在绝经期前随肿瘤恶性程度的增加而明显下降（P＜0．01），结论：男性胃癌患者血清T水平和女性结直肠癌患者血清E2水平，可作为判断患者病情的指标之一。     

Endocrine status of premenopausal node-positive breast cancer patients following adjuvant chemotherapy and long-term tamoxifen

The endocrine status of 49 premenopausal women taking tamoxifen after completion of adjuvant chemotherapy for breast cancer was determined by radioimmunoassay from serial blood samples. Of these 49 women, 7 had regular menses, 14 had irregular menses, 23 were amenorrheic, and 5 had undergone hysterectomies. A group of 12 premenopausal women who had no history of breast cancer and were not taking tamoxifen served as a control group. Evidence of ovarian function (estradiol levels of greater than 100 pg/ml) was seen in 7 of 7, 9 of 14, 2 of 23, and 1 of 5 women with a clinical history of regular menses, irregular menses, amenorrhea, and hysterectomy, respectively. Supraphysiological levels of estradiol (greater than 350 pg/ml) were noted in 13 of 19 women with endocrine evidence of ovarian function. Supraphysiological progesterone levels (greater than 20 ng/ml) were also seen in 5 of 7 of the regularly menstruating women taking tamoxifen. Supraphysiological levels of estradiol were associated with elevated follicle-stimulating hormone levels, but there was no mean change in the luteinizing hormone levels. Minimum and maximum serum follicle-stimulating hormone levels were 1.9 and 9.0 mIU/ml in the 12 normal women and 5.2 and 24.3 mIU in the 13 women with supraphysiological estradiol levels. Our findings demonstrate that the majority of women who continue to menstruate while taking continuous tamoxifen following cytotoxic chemotherapy have supraphysiologic estradiol levels. This is a potential mechanism for failure of tamoxifen therapy in these premenopausal women.     

Endocrine profile in breast cancer patients receiving chemotherapy

Summary Cyclophosphamide and other alkylating agents suppress ovarian function in pre-menopausal women. However, endocrine details remain unknown regarding the influence of patients' age and obesity on CMF-induced hormonal changes. We studied changes in endocrine profile due to chemotherapy (CMF) in 70 pre-menopausal patients with axillary node positive, stage II and/or III breast carcinoma. Plasma levels of estrone (E1), estradiol (E2), androstenedione (A2), luteinizing hormone (LH), and prolactin (PRL) were determined on day 1 and 8 of each chemocycle for 12 cycles. After receiving therapy, 23% of the women continued to have regular menstrual cycles (non-amenorrheic group). In the remaining 77%, ovarian function was suppressed, as evidenced by the onset of amenorrhea within 0–11 months (amenorrheic group). The mean time to amenorrhea was 2.83±0.33 months (SE). The time required to develop amenorrhea inversely correlated to the patient's age. Both incidence of amenorrhea and time to amenorrhea remained unaffected by either patients' obesity or the timing of chemotherapy initiation in relation to menstrual cycle phase (progestational, follicular). Plasma hormone levels fluctuated widely in both groups during the first three chemocycles. During chemocycle months 4 to 10, in the amenorrheic group, plasma E₁, E₂, and P declined to their baseline levels with a concomitant rise in LH levels. At this time, E₁, E2, and P levels were significantly lower in amenorrheics, despite menstrual cycle associated fluctuations in the non-amenorrheic group. Estrogens (E₁ and E₂) gradually declined further following the onset of amenorrhea in subsequent months. Further data analysis suggests that host age or obesity did not influence CMF-induced changes in the plasma endocrine profile.     

Inhibition of growth of MCF-7 MIII human breast carcinoma in nude mice by treatment with agonists or antagonists of LH-RH

Summary Human breast carcinoma (MCF-7 MIII), which exhibits an estrogen-independent but estrogenresponsive phenotype, was xenografted in 8–9-week-old intact female athymic nude mice without estrogen supplementation. In this model, we investigated inhibitory effects of the modern luteinizing hormonereleasing hormone (LH-RH) antagonist SB-75 and the agonist D-Trp⁶-LH-RH. The analogs were administered in the form of sustained delivery systems (microcapsules and microgranules). In the first experiment, treatment lasted 10 weeks. After 9 weeks of treatment, a significant inhibition of tumor volume was first found only in the group treated with SB-75, but the final tumor volume was significantly suppressed both by D-Trp⁶-LH-RH and SB-75. In the second experiment, treatment was started 70 days after tumor transplantation and was continued for 6 weeks. Chronic treatment with SB-75 or D-Trp⁶-LH-RH appeared to completely arrest tumor growth as measured by tumor volume, percentage change in tumor volume, and tumor weight. Serum estradiol was suppressed to undetectable levels and LH levels were also diminished. Histologically, the regressive changes in the treated tumors were due to the enhancement of apoptosis (programmed cell death) of tumor cells. Membrane receptor assays showed that LH-RH binding sites were down-regulated in tumor cells after treatment with SB-75 or D-Trp⁶-LH-RH.The results indicate that the antagonist SB-75, released from sustained delivery systems, can inhibit the growth of MCF-7 MIII tumors as effectively as the agonist D-Trp⁶-LH-RH, but more rapidly. In view of its immediate blockade of the pituitary-gonadal axis and the absence of side effects, the LH-RH antagonist SB-75 might be considered as a possible new hormonal agent for the treatment of breast cancer.Abbreviations LH-RH luteinizing hormone-releasing hormone - LH luteinizing hormone - FSH follicle-simulating hormone - D-Trp⁶-LH-RH D-tryptophan-6-luteinizing hormone-releasing hormone - IGF-I insulin-like growth factor I - EGF epidermal growth factor - Ac acetyl - Nal(2) 3-(2-naphthyl)alanine - Phe(4C1) 4-chlorophenylalanine - Pal(3) 3-(3-pyridyl)alanine - Cit citrulline     

Effects of postoperative adjuvant chemotherapy and radiotherapy on ovarian function in women undergoing treatment for soft tissue sarcoma

Ovarian function was evaluated in 11 women 16 to 43 years of age at treatment who received doxorubicin, cyclophosphamide, and high doses of methotrexate with or without radiotherapy in adjuvant therapy of soft tissue sarcoma. Five women (16-33 yr old) who received chemotherapy alone or combined with radiotherapy only at sites distant from the ovaries (chest wall, thigh, and leg) had minimal menstrual irregularities or temporary cessation of menses during therapy; cyclic menses returned promptly after therapy. Gonadotropin levels (expressed as means +/- SD [follicle-stimulating hormone (FSH), 10 +/- 5 mlU/ml; luteinizing hormone (LH), 10 +/- 4 mlU/ml] and 17 beta-estradiol (E2) levels (means +/- SD, 208 +/- 147 pg/ml) were normal. By contrast, 4 older women (ages 36-43 yr) who received similar treatment developed persistent amenorrhea with postmenopausal levels of gonadotropin (FSH, 108 +/- 29 mlU/ml; LH, 72 +/- 19 mlU/ml) and E2 (19 +/- 8 pg/ml). Two additional women (ages 21 and 39 yr) who received radiation (7,000 rad) to the pelvis plus chemotherapy developed prompt cessation of menses and became functional castrates (FSH, 77 and 80 mlU/ml; LH, 40 and 58 mlU/ml; E2, 10 and 19 pg/ml). However, this result would be expected from the radiation dose alone. The data demonstrated that ovarian dysfunction may follow the use of doxorubicin, cyclophosphamide, and high doses of methotrexate and that the injury is age related.     

抗苗勒氏管激素对绝经前早期乳腺癌患者化疗后卵巢功能的预测价值

  目的  探讨血清标志物抗苗勒氏管激素（anti-Mullerian hormone，AMH）等对出现化疗诱导闭经的绝经前早期乳腺癌患者是否卵巢功能衰竭（ovarian failure，OVF）的预测价值，以优化辅助治疗策略及保护生育功能。  方法  前瞻性分析2016年4月至2018年12月60例于广州医科大学附属第三医院行含环磷酰胺化疗方案的绝经前早期乳腺癌患者临床资料，监测化疗前后血清中的AMH、卵泡刺激素（follicle stimulating hormone， FSH）和雌二醇（estradiol，E2）水平变化。根据化疗结束后中位随访时间24个月时，E2、FSH是否维持在绝经后参考范围内，分为OVF组和卵巢功能恢复（ovarian recovery，OVR）组，分析对化疗后OVF的预测价值。  结果  化疗前AMH预测化疗后24个月卵巢功能的曲线下面积（area under curve，AUC）为0.837（95%CI 为0.719～0.920），年龄联合化疗前血清AMH等预测的AUC为0.924（95%CI 为0.826～0.977）。化疗前的AMH≤1.05 ng/mL，1个疗程化疗后AMH≤0.56 ng/mL，化疗结束后3～6个月FSH>25.01 U/L及诊断年龄>37岁的阴性预测值均为100%。  结论  血清AMH联合E2 和FSH检测对鉴别绝经前早期乳腺癌患者化疗后是否OVF有重要价值，可将AMH纳入化疗前常规检测。      

宫颈癌术后激素水平的改变与术后恶心及呕吐的关系

背景与目的:术后恶心、呕吐(post operative nausea and vomiting,PONV)是一种常见的妇科手术后并发症,发生率较其他腹部手术高3倍以上,可能与手术前后体内雌性激素的变化相关。通过比较手术前后患者体内雌激素(estradiol)、孕激素(progesterone)、黄体生成素(luteinizing hormone,LH)和卵泡刺激素(follicle stimulating hormone,FSH)水平的变化,探讨其与PONV的关系。方法:选择20例在连续硬膜外麻醉复合全身麻醉下行宫颈癌根治手术的患者,在术前、手术结束时及术后5、10及20 h测定其血清雌激素、孕激素、LH和FSH的数值,并在术后5、10及20 h时分别随访患者的恶心呕吐、情况。结果:所有患者的雌激素、孕激素、FSH、LH在术后均有明显的下降。雌激素、FSH和LH的下降与术后恶心、呕吐的发生没有明显关系(P>0.05)。孕激素的下降与术后恶心呕吐发生率呈负相关(P<0.05)。结论:低孕激素水平也许是术后恶心、呕吐的高危因素。     

Dynamics of hormonal disorders following unilateral orchiectomy for a testicular tumor

Testicular tumors and their treatment interfere with homeostasis, hormonal status included. The aim of the study was to evaluate hormonal disorders of the pituitary–gonadal axis in men treated for testicular tumors. One hundred twenty-eight men treated for a unilateral testicular tumor at our institution were included. The hormonal status was prospectively evaluated in 62 patients before orchiectomy, 120 patients 1 month after orchiectomy and 110 patients at least 1 year after the treatment. The concentrations of human chorionic gonadotropin (hCG), testosterone (T), estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were measured. The clinically significant testosterone deficiency was defined either as testosterone <2.31 ng/mL or testosterone within the range of 2.31–3.46 ng/mL but simultaneous with T/LH ratio ≤1. Changes in hormone levels were significant: LH and FSH rose in the course of observation, and the concentration of hCG, testosterone, estradiol decreased. PRL concentration was the lowest at 1 month after orchiectomy. In multivariate analysis, the risk of the clinically significant testosterone deficiency was 0.2107 (95% CI 0.1206–0.3419) prior to orchiectomy, 0.3894 (95% CI 0.2983–0.4889) 1 month after surgery and 0.4972 (95% CI 0.3951–0.5995) 1 year after the treatment. The estradiol concentration was elevated in 40% of patients with recently diagnosed testicular cancer and that was correlated with a higher risk of testosterone deficiency after the treatment completion. Hormonal disorders of the pituitary–gonadal axis in men treated for testicular tumors are frequent. The malignant tissue triggers paraneoplastic disorders that additionally disturb the hormonal equilibrium.     

Hormonal study in patients developing amenorrhea during adjuvant chemotherapy for breast cancer.

The sera of 15 premenopausal women with operable breast cancer and who had developed amenorrhea during adjuvant chemotherapy with cyclophosphamide + methotrexate + fluorouracil were analyzed for the following hormones: 17-beta-estradiol, luteinizing hormone, thyroid stimulating hormone and prolactin. The blood levels did not differ significantly from those found in patients operated on for breast cancer and in spontaneous menopause (controls). These origins suggest that the amenorrhea induced by CMF chemotherapy is of ovarian origin.     

Recovery of serum testosterone, LH and FSH levels following neoadjuvant hormone cytoreduction and radical radiotherapy in localized prostate cancer

This study was carried out to evaluate the possible long-term endocrine effect of short-term neoadjuvant leuteinizing hormone-releasing hormone analogue (LHRHa) administration in localized prostate cancer. A total of 419 men were treated for 3-6 months at The Royal Marsden NHS Trust by neoadjuvant androgen suppression using monthly depot injections of LHRHa before radical radiotherapy. Serum testosterone (852 measurements), leuteinizing hormone (LH) (799 measurements), and follicle-stimulating hormone (FSH) levels (801 measurements) were grouped according to their timing in relation to hormonal treatment and then analysed. Suppression of pituitary gonadotrophins and testosterone after the administration of LHRHa and their recovery after cessation of the drug was clearly observed. Median serum testosterone levels decreased from 16 nmol/l to 14 nmol/l when comparing prehormonal and follow-up phases. The same comparison showed an increase in median serum LH and FSH levels, with the median LH rising from 5 u/l to 8 u/l and the median serum FSH rising from 6 u/l to 20 u/l. On long-term follow-up, three of 256 men have remained with testosterone levels in the castrate range. Similar highly significant results were seen in subgroup of 103 men who had both pre-LHRHa and follow-up hormone levels analysed (P=0.012, P<0.001, P<0.001 for testosterone, LH and FSH respectively). Our data suggest the possibility of residual gonadal dysfunction after short-term LHRHa administration and radical radiotherapy in localized prostate cancer. Serum testosterone levels are restored to normal levels in the majority of patients, with a compensatory increase in serum levels of LH.