The role of GnRH analogues in the treatment of endometriosis

Shaw, Robert W.

doi:10.1111/j.1471-0528.1992.tb13532.x

Cited by 32 publications

(11 citation statements)

References 23 publications

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“…The depot injections are favoured by many clinicians because of the consistency of the endocrine response and better patient compliance. All the analogues exert their beneficial effects by down‐regulation of the gonadotrope with consequent suppression of luteinising hormone (LH) and follicle stimulating hormone (FSH); oestradiol (E 2 ) levels also fall, leading to the widely experienced hypo‐oestrogenaemic side effects that are similar with each preparation (Shaw 1992). The medical oophorectomy created causes a marked regression but not the disappearance of endometriotic deposits and the improvement in symptoms.…”

Section: Discussionmentioning

confidence: 99%

Multiple gestation following gonadotrophin releasing hormone therapy for the treatment of minimal endometriosis

Pickersgill

Kingsland

Garden

et al. 1994

BJOG

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Section: Discussionmentioning

confidence: 99%

Multiple gestation following gonadotrophin releasing hormone therapy for the treatment of minimal endometriosis

Pickersgill

Kingsland

Garden

et al. 1994

BJOG

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“…He required no other medications during his hospitalization. A repeat complete blood count did show an increase in both RBC and hematocrit to 4.11 M/mm 3 and 38.3%, respectively. He was discharged home with appropriate follow-up after 13 days of inpatient hospital treatment.…”

mentioning

confidence: 87%

Manic and Psychotic Symptoms Following Subcutaneous Leuprolide in a Male Patient With No Prior Psychiatric History

Chavez¹,

Reilly²

2010

J. Clin. Psychiatry

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To the Editor: Leuprolide is a synthetic luteinizing hormonereleasing hormone (LHRH) agonist used in the treatment of advanced prostate cancer. It is available as an immediate-release intramuscular injection, a depot suspension for intramuscular injection, and an extended-release suspension for subcutaneous injection. After a 45-mg dose of subcutaneous leuprolide, 99.1% of patients experience clinical castration by day 28, defined as serum testosterone levels < 50 ng/mL. 1 In addition to this decrease in serum testosterone levels, decreases in sex hormone-binding globulin and estradiol are also seen. 1,2 Although there have been reports 3,4 of emotional lability, depression, and anxiety with LHRH agonists, the data are not consistent. Furthermore, all published reports on psychiatric side effects of LHRH agonists have been exclusively in female patients. The package insert 1 of leuprolide depot subcutaneous injection does list anxiety, depression, and delusions as occurring in less than 5% of patients. Here, we describe a case of a 65-year-old man with no prior psychiatric history who developed manic and psychotic symptoms after receiving a 45-mg subcutaneous injection of leuprolide. This is the only case available in the literature that describes a male patient experiencing such severe psychiatric symptoms in association with leuprolide.Case report. Mr A, a 65-year-old white man, was brought into the emergency department by the police after they were called by his wife. She reported that he was extremely agitated, shouting profanities, threatening her, and accusing her of being schizophrenic. Over the last 3 to 4 weeks, he had been progressively sleeping less, only sleeping 1 to 2 hours per night immediately prior to admission. He had persecutory delusions regarding the Mafia and FBI. He was hyperverbal, had pressured speech, and was repeatedly quoting the Bible. Over the past several weeks, he had been displaying bizarre behavior, such as impulsively buying objects he had no use for and excessively spending money. He had also been irritable with his wife and using profanity, which was unusual behavior for him. At the time of admission, an accurate history could not be obtained

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“…Die diversen auf dem Markt befindlichen GnRH-Agonisten sind hinsichtlich Schmerzreduktion und Endometrioseregression ähnlich effektiv, wie eine Übersichtsarbeit von Shaw [35] zeigte. Allerdings haben noch 50 der Patientinnen nach 6-monatiger Therapie mehr oder weniger narbige Restherde, die noch vitale endometriale Drüsen und Stroma enthalten, was erstmalig von unserer Arbeitsgruppe [31] morphologisch gezeigt werden konnte und später von Ruwe et al [29] für Leuprorelin und Buserelin bestätigt wurde.…”

Section: Vergleich Der Verschiedenen Gnrh-analogaunclassified

GnRH-Analoga in der Endometriosetherapie

Schweppe¹

2006

Gynäkologische Endokrinologie

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ArzneimitteltherapieMit den derzeitigen Therapieoptionen bei Endometriose -chirurgisch und/oder medikamentös -kann keine komplette und dauerhafte Beseitigung der Beschwerden erwartet werden. Es sind häufig wiederholte Behandlungen erforderlich, deshalb spielt nicht nur die Wirksamkeit einer Substanz eine Rolle, sondern auch deren Verträglichkeit und ein geringes individuelles Nebenwirkungsprofil sind von entscheidender Bedeutung. Mit GnRH-Agonisten kann das Therapieprinzip des reversiblen Östrogen-entzugs bei Endometriose vollstän-dig erreicht werden. Dabei kommt es jedoch zu einer individuell unterschiedlich ausgeprägten Demineralisierung des Knochens, der durch Addback-Medikamente begegnet werden kann.GnRH-Analoga werden in Antagonisten und Agonisten unterteilt. Erstere erreichen durch Blockade der GnRH-Rezeptoren an der Adenohypophyse eine sofortige Suppression der FSH-und LH-Sekretion und damit der Funktion der Gonaden. In der assistierten Reproduktion und im onkologischen Bereich (Prostatakarzinom) haben klinische Studien den Wert dieser Substanzgruppe untermauert [30], während bei benignen proliferativen Erkrankungen der Frau die GnRH-Agonisten klinische Routine geworden sind. Sie wurden als neues Therapieprinzip für Endometriose vor bereits mehr als 22 Jahren eingeführt [18], dennoch gibt es bis heute international keinen Konsens über ihre Rolle im Management der Erkrankung.Die Anforderungen im Entscheidungsprozess über eine optimale Therapie der Endometriose sind hoch, da deren Ursache und Pathogenese wissenschaftlich bisher nur partiell geklärt sind und das Spektrum der therapeutischen Optionen von Operation über verschiedene hormonelle Suppressionstherapien bis hin zur symptomatischen Analgetikagabe reicht. Ferner sind die individuellen Erwartungen und Probleme der Patientin zu beachten, wie u. a. ihre Beschwerden, ihre Familienplanung, ihre Bereitschaft hinsichtlich chirurgischen Eingriffen oder zur Akzeptanz von Nebenwirkungen, ihr Alter und der bisherige Krankheitsverlauf.

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The role of GnRH analogues in the treatment of endometriosis

Cited by 32 publications

References 23 publications

Multiple gestation following gonadotrophin releasing hormone therapy for the treatment of minimal endometriosis

Multiple gestation following gonadotrophin releasing hormone therapy for the treatment of minimal endometriosis

Manic and Psychotic Symptoms Following Subcutaneous Leuprolide in a Male Patient With No Prior Psychiatric History

GnRH-Analoga in der Endometriosetherapie

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