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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Gonadotropin-releasing hormone (GnRH) agonists are widely used in clinical gynecologic practice for the treatment of endometriosis and uterine leiomyomas. Leuprolide acetate (Lupron) is an agent that is frequently used for these conditions. Although no epidemiological studies are published of infants born following Lupron therapy, it is unlikely that the risk of congenital anomalies is high following exposure to this drug during pregnancy (Friedman and Polifka, 2006). Chronic administration of agonists downregulates the pituitary gonadotropin receptors, thereby suppressing release of LH and FSH, leading to a hypoestrogenic state. The likelihood of pregnancy occurring while a woman is given GnRH agonists is extremely low. However, GnRH agonists may also be used prior to HMG therapy in infertile women undergoing in vitro fertilization cycles. Typically, administration is begun in the luteal phase of the cycle, when a patient may be in the early stage of a pregnancy. No epidemiologic studies are published on the risk malformations in the offspring of women treated with this drug during pregnancy.
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
As with other GnRH agonist analogues, common side effects include fatigue, muscle weakness, paresthesia, hot flashes, arthralgia, hyperhidrosis, palpitations, peripheral edema, bone pain, hypertension, depression, gynecomastia, jaundice, sexual dysfunction, testicular atrophy, and alterations in glucose tolerance and blood lipids. Thrombocytopenia and leukopenia have also been reported.
Minimizing Blood Loss
Published in John C. Petrozza, Uterine Fibroids, 2020
Elise Bardawil, Jessica B. Spencer
Pretreatment with GnRH agonists can be used for patients undergoing hysteroscopic myomectomy. Research about this topic focuses on ease of surgery, decreasing fluid deficits, and patient satisfaction. Few studies look at limiting blood loss, likely because blood loss is quite minimal in these cases. One randomized controlled trial compared the use of vaginal danazol 200 mg twice a day for 30 days preoperatively with intramuscular diphereline given twice, 28 days apart. The outcomes were impressive, showing that 78.1% of the danazol group had no intraoperative bleeding versus 19.4% in the diphereline group. Unfortunately, this study did not have a control population [16]. A multicenter, prospective, randomized trial looked at immediate hysteroscopic myomectomy versus a 2-month trial of GnRH analogues preoperatively. Although this study did not examine intraoperative blood loss, the authors did report a shorter operative time with less difficulty of procedures in the pretreatment group [17]. One can extrapolate that the GnRH agonists influence the operative time by decreasing the starting size of the submucosal fibroids and by reducing their blood supply. Both of these factors likely decrease the intraoperative blood loss during these surgeries. As previously mentioned though, GnRH agonists are expensive and have several side effects, so they are not routinely used in our practice.
From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach
Published in Gynecological Endocrinology, 2022
Patrycja Rojewska, Blazej Meczekalski, Grzegorz Bala, Stefano Luisi, Agnieszka Podfigurna
Androgen-secreting ovarian tumors are rare, constituting around 1% of all ovarian tumors. Typically, these tumors manifest with rapidly increasing hyperandrogenization, specifically hirsutism, acne, frontal balding, and in more severe cases virilization. Careful and insightful diagnostics should be undertaken in every case of hyperandrogenism. The diagnostic process should include a thorough medical interview, physical examination (with the assessment of hirsutism using the modified Ferriman-Gallwey scale), laboratory tasting (serum testosterone, DHEA-S, androstenedione, 17-OHP levels), comprehensive imaging (Preliminary TVU with color Doppler preferred), and MRI. Most often, ASNs originate from the cells of the sex cord or stroma of the ovary. Sertoli-Leydig Cell Tumors, which in 75% of cases affect women under the age of 30 years, is the most frequently occurring ASN, while Leydig Cell Tumors are more commonly diagnosed in postmenopausal women. Both SLCT and LCT are typically unilateral and benign. If there are no preexisting contraindications, ovarian tumors should be treated surgically with bilateral oophorectomy. In the presence of unmitigable contraindications, treatment with GnRH agonists can be considered. Other tumors, such as SCSTs and metastases (mostly of a gastric origin) are also seen but the incidence of these is comparatively low.
The effects of luteinising hormone gene polymorphism on the outcomes of in vitro fertilisation and embryo transfer
Published in Journal of Obstetrics and Gynaecology, 2021
Yeonhee Ku, Min A. Hong, Soo Jin Chae, Kyung Sil Lim, Won-Don Lee, Jin Ho Lim, Young Min Choi
The clinical pregnancy rate was significantly lower in the carrier group than in the noncarrier group in GnRH antagonist cycles but not in IVF cycles with the long GnRH agonist protocol. There might be differences between the two protocols, which could explain the results of this study. Endogenous LH has been reported to be suppressed in IVF cycles with the GnRH antagonist protocol (Albano et al. 1997), and serum LH level has been found to be significantly lower in GnRH antagonist cycles than in long GnRH agonist cycles (Barmat et al. 2005). Pregnancy rates were similar in GnRH antagonist and long GnRH agonist cycles but in favour of long GnRH agonist cycles. Several studies have evaluated the effect of LH supplementation in GnRH antagonist cycles and found no additional benefit with LH supplementation in a general IVF population (Tarlatzis et al. 2006).
Relugolix: A new kid on the block among gonadotrophin-releasing hormone antagonists
Published in Arab Journal of Urology, 2021
Charalampos Fragkoulis, Ioannis Glykas, Athanasios Dellis, Iraklis Mitsogiannis, Athanasios Papatsoris
GnRH antagonists provide a more rapid castration compared with GnRH agonists as they bind to the pituitary GnRH receptors in a competitive way resulting in testosterone suppression to castration levels avoiding at the same time the testosterone ‘flare-up’ phenomenon described when GnRH agonists are used [3]. As GnRH antagonists do not provoke a testosterone flare-up phenomenon and that testosterone surges during maintenance with GnRH agonists are also avoided, they present an excellent treatment option in patients with symptomatic prostate cancer, especially those who present with bone pain, ureteric or BOO, bone fractures or spinal cord compression [4]. In addition, simultaneous administration of antiandrogen is not necessary. Despite initial drawbacks related to histamine mediated adverse events described with abarelix use, degarelix is currently widely used as the sole GnRH antagonist approved both in Europe and the USA [4]. Degarelix is a third generation GnRH antagonist administered by monthly injections starting at 240 mg the first month followed by 80 mg monthly [5]. As all available options regarding ADT are based on injectable formulas, there is wide interest in developing orally administered GnRH antagonists in order to avoid severe injection side reactions including pain, erythema, pruritus and swelling, which are common with degarelix [6].