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Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
The side effects of GnRH agonists relate mainly to the inhibition of testosterone and estrogen in men and women, respectively. In women this includes menopausal-like symptoms (e.g., hot flushes, increased sweating, loss of libido, vaginal dryness, and dyspareunia) and a decrease in trabecular bone density. In men, the ablation of testosterone usually leads to loss of libido, weight gain and other symptoms of feminization. Other side effects in both males and females include hypersensitivity reactions (e.g., rashes, pruritus, asthma, and rarely anaphylaxis), injection-site reactions, headache (rarely migraine), visual disturbances, dizziness, arthralgia and hair loss, myalgia, peripheral edema, gastrointestinal disturbances, weight changes, sleep disorders, and mood changes. Men at risk of “tumor flare” should be monitored closely during the first month of therapy, and the use of GnRH analogues in pregnancy and breastfeeding is contraindicated. Spray formulations can cause irritation of the nasal mucosa including nose bleeds.
Fibroid and Infertility
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Aarti Deenadayal Tolani, Kadambari, Hema Desai, Suhasini Donthi, Mamata Deenadayal
Treatment options are mainly medical and surgical. Medical treatments delay the time to conception and hence are not preferred for infertility patients. They are used mainly in large mucous myomas to reduce the size prior to surgery. Gonadotropin-releasing hormone (GnRH) analogues are the mainstay of treatment.
Late Effects of Treatment for Childhood Brain and Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Ralph Salloum, Katherine Baum, Melissa Gerstle, Helen Spoudeas, Susan R. Rose
Sara’s medulloblastoma was diagnosed when she was 4 years old. She underwent surgery, craniospinal irradiation, and chemotherapy. During the next 2 years, magnetic resonance imaging (MRI) scans showed no tumor and she seemed to grow well along the 25th percentile, although her stamina remained low. She required naps and laxatives and cried easily. On physical examination at age 6 years, her pulse was 65 beats/min, temperature 35°C, lung and heart examination normal, abdomen firm (with stool), breast development consistent with Tanner stage 3, and pubic hair stage consistent with Tanner 1. She was found to have precocious puberty, along with central hypothyroidism, ACTHD, and GHD. (Of note, her growth rate was normal probably because the precocious puberty sped up her growth, compensating for slowed growth from hypothyroidism and GHD (Figure 21.4).) She was started on hydrocortisone therapy, then after 2 days, on thyroid hormone therapy. Gonadotropin-releasing hormone (GnRH) analog therapy was initiated. Her growth rate slowed over the next 6 months. The use of GH therapy was reviewed with her oncologist and was approved in view of her continued stable MRI. She started GH replacement with improved growth rate. GH dose was adjusted to keep serum insulin-like growth factor-1 (IGF-1) concentration near the mean for age.
The LH endocrine profile in gonadotropin-releasing hormone analogue cycles
Published in Gynecological Endocrinology, 2022
Lara Janssens, Ella Roelant, Diane De Neubourg
To understand LH suppression by GnRH analogues, one needs to understand the difference between the GnRH agonist and the GnRH antagonist. Both cause a transient suppression of endogenous LH to prevent premature ovulation, but the mode of action of both analogues differs. In 1978, it was discovered that the administration of GnRH agonists causes an initial flare up effect, characterized by a transient increase in LH levels [13]. After one to three weeks, desensitization and downregulation of the pituitary lead to the loss of GnRH receptors. GnRH antagonists on the other hand, competitively block the GnRH receptor, providing a direct suppression of LH levels for a period of 24 to 72 h. By preserving pituitary gland responsiveness, GnRH antagonists ensure a fast recovery after cessation [9, 14].
Pituitary adenoma and apoplexy during GnRH agonist treatment for IVF - case report
Published in Gynecological Endocrinology, 2020
Aneta Stefaniak, Jan Domitrz, Katarzyna Siewko, Małgorzata Szelachowska, Adam Krętowski, Alicja Stachura-Matyjewicz
In vitro fertilization (IVF) is commonly used for treating infertility. One stage of this process is controlled hyperstimulation of the ovaries, achieved by administering gonadotropins. There are several stimulation protocols utilized that increase the number of ovarian follicles during IVF. The most common protocol employs desensitization - the inhibition of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion by the pituitary gland. This is achieved by administering a GnRH analog that is agonistic for the GnRH receptor. The drug is most commonly administered from the halfway point of the luteal phase of the preceding cycle. Administration of 50–100 µg of GnRH agonist directly inhibits gonadoliberin secretion and indirectly inhibits FSH, LH, and estradiol after around 10–14 days. However the use of a this drug during therapy carries a risk of complications. The most common complication of using a GnRH agonist with gonadotropins is ovarian hyperstimulation syndrome (OHSS). Rarer complications include ovarian cysts, reduced bone density, and mood changes with depressive characteristics. Extremely rare complications encompass such issues as pulmonary artery embolism, myocardial infarction, and pituitary apoplexy caused by a previously clinically inactive pituitary tumor called gonadotropinoma.
Does the type of GnRH analogue used, affect live birth rates in women with endometriosis undergoing IVF/ICSI treatment, according to the rAFS stage?
Published in Gynecological Endocrinology, 2018
Panagiotis Drakopoulos, Jérôme Rosetti, Nicola Pluchino, Christophe Blockeel, Samuel Santos-Ribeiro, Michael de Brucker, Petros Drakakis, Michel Camus, Herman Tournaye, Nikolaos P. Polyzos
In conclusion, the chance to have a liveborn in endometriosis population seems not to be affected by the type of GnRH analog used, at least in stages III–IV (rAFS). The shorter duration of administration and the lower dose of gonadotropins used in the GnRH antagonist protocol, support the use of GnRH fixed dose protocol as alternative over the GnRH agonist long protocol in patients with advanced endometriosis. Furthermore, the absence of hypo-estrogenic side effects, the lower incidence of ovarian cyst formation and OHSS in GnRH antagonist protocols might further support this option and should be taken seriously into consideration by clinicians treating severe endometriosis cases. Findings from stage I–II endometriosis cases merit consideration and further evaluation in a larger sample size is warranted.