Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis

Friedman, Andrew J.; Lobel, Susan M.; Rein, Mitchell S.; Barbieri, Robert L.

doi:10.1016/0002-9378(90)90667-v

Cited by 136 publications

(58 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our patient treated with GnRH-a for uterine leiomyoma had a higher lipid signal in spite of her young age. This may be a result of cellular atrophy due to a decrease in myofilaments in the leiomyoma resulting from GnRH-a treatment [26]. The incidence of lipid peak was not significantly higher in uterine leiomyomas than in control group myometrium (¯2 1.37, p 1 0.05).…”

Section: Discussionmentioning

confidence: 82%

Magnetic Resonance Spectroscopy Features of Uterine Leiomyomas

Çelik

Saraç

Hasçalık

et al. 2004

Gynecol Obstet Invest

View full text Add to dashboard Cite

Objective: The purpose of this study is to investigate the in vivo magnetic resonance spectroscopy features of uterine leiomyomas using long echo time and to characterize the spectral patterns of these lesions. Methods: We calculated metabolites in 15 patients with uterine leiomyomas and myometrium of 20 healthy control subjects using single-voxel proton MR spectroscopy (point resolved spectroscopy technique, TE:136 ms). Voxels were placed at the center of the uterine leiomyomas. The peak areas of creatine, choline, lipid and lactate were determined. The MR spectroscopy results of uterine leiomyomas were compared with the spectroscopy results obtained from the myometrium of healthy control subjects. Results: The characteristically obtained signal was choline, which was detected not only in 14 of the 15 leiomyomas (93.3%) but also in 18 of the 20 myometrium of control subjects (90%). The lipid signals were determined in 9 of 15 patients with uterine leiomyomas (60%) and 8 of 20 control subjects (40%). The lactate signal was obtained from six of 15 patients with leiomyomas (40%) but only two of myometrium (10%). The creatine signal was obtained from 4 of 15 patients with leiomyomas (26.6%) and 5 of 20 myometrium (25%). Among the tested parameters only lactate peak was statistically significant (p < 0.05). Conclusion: Proton MR spectroscopic imaging may be helpful for the investigation of the underlying pathophysiology of uterine leiomyomas. The presence of lactate and lipid signals in the spectrum may be a useful indicator of metabolic pathway of uterine leiomyomas.

show abstract

Section: Discussionmentioning

confidence: 82%

Magnetic Resonance Spectroscopy Features of Uterine Leiomyomas

Çelik

Saraç

Hasçalık

et al. 2004

Gynecol Obstet Invest

View full text Add to dashboard Cite

show abstract

“…Unfortunately, use of these agents as the sole therapy for fibroids is limited by the rapid enlargement of the myomas to near pretreatment size following cessation of the GnRH agonist therapy (Friedman et al 1989) and by the concern for potential bone resorption with long-term administration of the drugs (Friedman et al 1990). However, GnRH analogs have been used as preoperative therapy to reduce the size of fibroids prior to hysterectomy; this approach has resulted in reports of significantly less blood loss at operation (Lumsden et al 1987) and increased feasibility of vaginal rather than abdominal hysterectomy, accompanied by shorter hospitalizations (Stovall et al 1991).…”

Section: Clinical Observationsmentioning

confidence: 99%

Etiology and pathogenesis of uterine leiomyomas: a review.

Flake

Andersen

Dixon

2003

Environ Health Perspect

490

392

View full text Add to dashboard Cite

Uterine leiomyomas, or fibroids, represent a major public health problem. It is believed that these tumors develop in the majority of American women and become symptomatic in one-third of these women. They are the most frequent indication for hysterectomy in the United States. Although the initiator or initiators of fibroids are unknown, several predisposing factors have been identified, including age (late reproductive years), African-American ethnicity, nulliparity, and obesity. Nonrandom cytogenetic abnormalities have been found in about 40% of tumors examined. Estrogen and progesterone are recognized as promoters of tumor growth, and the potential role of environmental estrogens has only recently been explored. Growth factors with mitogenic activity, such as transforming growth factor-β 3, basic fibroblast growth factor, epidermal growth factor, and insulin-like growth factor-I, are elevated in fibroids and may be the effectors of estrogen and progesterone promotion. These data offer clues to the etiology and pathogenesis of this common condition, which we have analyzed and summarized in this review.

show abstract

“…Simultaneous medroxyprogesterone acetate with GnRHa has been observed to reduce side effects but also to block the expected leiomyomal decrease in size [10]. However, GnRHa treatment followed by replacement therapy with oestrogen and progestin brought about a decrease in hypo-oestrogenic symptoms and also in most cases brought about leiomyomal shrinkage [11,12]. In the present study, nafarelin-treated leiomyomas were reduced in size only in 3 cases of 7 and 3 patients complained of hypo-oestrogenic side effects.…”

Section: Discussionmentioning

confidence: 56%

GnRH Analogues and Uterine Leiomyomas

Rintala

Kujansuu²,

Teisala³

et al. 1999

Gynecol Obstet Invest

View full text Add to dashboard Cite

Cell proliferation in uterine leiomyomas treated preoperatively with either nafarelin (400 μg/day) for 3 months (7 patients) or nafarelin plus hormone (oestradiol + norethisterone) add-back therapy (6 patients) was investigated by automatic image analysis of frozen tissue sections using immunohistochemistry with anti-proliferating cell nuclear antigen antibody. GnRHa therapy decreased cell proliferation in leiomyomas to a level corresponding to the situation previously seen in postmenopausal leiomyomas. However, there was no consistent correlation between cell proliferation and shrinkage of leiomyomal size. The hormone add-back therapy moderated the influence of GnRHa on cell proliferation and completely blocked a decrease in size of leiomyomas in our patients.

show abstract

Efficacy and safety considerations in women with uterine leiomyomas treated with gonadotropin-releasing hormone agonists: The estrogen threshold hypothesis

Cited by 136 publications

References 14 publications

Magnetic Resonance Spectroscopy Features of Uterine Leiomyomas

Magnetic Resonance Spectroscopy Features of Uterine Leiomyomas

Etiology and pathogenesis of uterine leiomyomas: a review.

GnRH Analogues and Uterine Leiomyomas

Contact Info

Product

Resources

About