Primary Hyperparathyroidism after Menopause

Osteoporosis is an important disease which can affect millions of patients all over the world, leading to complications, often even to death. Prevention and the early diagnosis may help in the success of treatment but there are diseases which can occur at the same time. Primary hyperparathyroidism is a diagnosis which must be remembered in women after the menopause.A osteoporose é uma doença que acomete milhões de pacientes no mundo inteiro, levando a complicações muitas vezes graves e até ao óbito. A prevenção e o diagnóstico precoce se fazem necessários para o sucesso da terapêutica, porém existem doenças que podem cursar concomitantemente. O hiperparatiroidismo primário é um diagnóstico que deve ser lembrado em mulheres na pós-menopausa.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Effect of hormone replacement therapy on the bone mass and urinary excretion of pyridinium cross-links

CONTEXT: The menopause accelerates bone loss and is associated with an increased bone turnover. Bone formation may be evaluated by several biochemical markers. However, the establishment of an accurate marker for bone resorption has been more difficult to achieve. OBJECTIVE: To study the effect of hormone replacement therapy (HRT) on bone mass and on the markers of bone resorption: urinary excretion of pyridinoline and deoxypyridinoline.DESIGN: Cohort correlational study.SETTING: Academic referral center.SAMPLE: 53 post-menopausal women, aged 48-58 years.MAIN MEASUREMENTS: Urinary pyr and d-pyr were measured in fasting urine samples by spectrofluorometry after high performance liquid chromatography and corrected for creatinine excretion measured before treatment and after 1, 2, 4 and 12 months. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) before treatment and after 12 months of HRT.RESULTS: The BMD after HRT was about 4.7% (P < 0.0004); 2% (P < 0.002); and 3% (P < 0.01) higher than the basal values in lumbar spine, neck and trochanter respectively. There were no significant correlations between pyridinium cross-links and age, weight, menopause duration and BMD. The decrease in pyr and d-pyr was progressive after HRT, reaching 28.9% (P < 0.0002), and 42% (P < 0.0002) respectively after 1 year.CONCLUSIONS: Urinary pyridinoline and deoxypyridinoline excretion decreases early in hormone replacement therapy, reflecting a decrease in the bone resorption rate, and no correlation was observed with the bone mass evaluated by densitometry.CONTEXTO: A perda óssea acelerada observada na pós menopausa é atribuída a um incremento do turnover ósseo, com predomínio da reabsorção em decorrência da falência ovariana. Ao contrário da formação tem sido difícil de estabelecer um marcador sensível de reabsorção.OBJETIVOS: Avaliar o efeito da terapia de reposicão hormonal (TRH) na densidade e nos marcadores urinários de reabsorção óssea, piridinolina (PIR) e deoxipiridinolina (D-PIR).TIPO DE ESTUDO: Estudo coorte de correlação.LOCAL: Centro universitário de referência.PACIENTES: 53 mulheres menopausadas há 3,6 ± 5 anos, idade mediana de 53 anos.VARIÁVEIS ESTUDADAS: A excreção urinária de PIR e D-PIR na urina de jejum ,analisada por HPLC e expressa em pmol /mmol de creatinina ,foi avaliada em condições basais e após 1,2,4 e 12 meses de TRH. Realizaram densitometria óssea (DO) em coluna e fêmur antes e após 12 meses de TRH.RESULTADOS: A DO após TRH foi 4.7%(P<0.0004); 2%(P<0.002); and 3%(P<0.01) maior que os valores basais na coluna , colo do fêmur e trocanter respectivamente. Observou-se um decréscimo dos valores de PIR e D-PIR precoce e progressivo, atingindo 28,9% (P<0.0002) e 42% (P<0.0002) após 1ano de TRH respectivamente. Não houve correlação entre os valores de DO e os de PIR E D-PIR.CONCLUSÕES: A excreção urinária de PIR e D-PIR constituem um marcador sensível da reabsorção óssea.O decréscimo precoce a torna útil na avaliação da eficácia terapeutica.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Testosterone therapy for women with low sexual desire : a position statement from the Brazilian Society of Endocrinology and Metabolism

Objective: To summarize current evidence regarding testosterone treatment for women with low sexual desire. Materials and methods: The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies. Results: Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women. Conclusion: Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription

Polycystic ovary syndrome: clinical and laboratory evaluation

OBJECTIVE: To evaluate clinically, and with laboratory, tests, women with polycystic ovary syndrome (PCO). PATIENTS: One hundred and twelve women with PCO were studied. METHODS: The following data was recorded: Current age; age at menarche; menstrual irregularity, occurrence of similar cases in the family; fertility, obstetric history; body mass index (BMI); and presence of hirsutism. Serum measurements of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, free testosterone, and dehydroepiandrosterone sulfate were taken. RESULTS: All patients presented either oligomenorrhea (31 percent), periods of secondary amenorrhea (9 percent), or both alterations (60 percent). The majority of the patients were infertile (75.6 percent). The LH/FSH ratio was higher than 2:1 in 55 percent of the patients and higher than 3:1 in 26.2 percent. The ultrasonographic aspect of the ovaries was considered to be normal in 31 percent. CONCLUSION: The main clinical feature of the PCO is the irregularity of menses since menarche, and that the laboratory tests would be important to exclude other disorders such as hyperprolactinemia or hyperandrogenemia caused by late-onset congenital adrenal hyperplasia.OBJETIVOS: Avaliar clinica e laboratorialmente mulheres com a síndrome dos ovários policísticos (SOP). PACIENTES: Foram estudadas 112 mulheres com SOP. MÉTODOS: Avaliamos idade, idade da menarca, história menstrual, época do aparecimento da irregularidade menstrual, ocorrência de casos semelhantes na família, antecedentes obstétricos, índice de massa corpórea, e presença de hirsutismo. Foram realizadas as dosagens séricas de hormônio foliculo-estimulante (FSH), hormônio luteinizante (LH), prolactina, testosterona livre e de sulfato de dehidroepiandrosterona. RESULTADOS: Todas as mulheres apresentavam espaniomenorréia (31 percent), períodos de amenorréia secundária (9 percent) ou ambas alterações (60 percent). A maioria era infértil (75,6 percent). A relação LH/FSH era maior que 3 em 26,2 percent e maior que 2 em 55,0 percent das mulheres. O aspecto ultra-sonográfico dos ovários era normal em 31 percent das mulheres. CONCLUSÃO: A principal característica clínica da SOP é a irregularidade menstrual desde a menarca e os exames de laboratório seriam importantes para afastar outras patologias como as síndromes hiperprolactinêmicas ou as deficiências enzimáticas tardias da supra-renal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of GynecologyUNIFESP, EPM, Department of GynecologySciEL

SERUM LEVELS OF ANDROSTANEDIOL GLUCURONIDE, TOTAL TESTOSTERONE, AND FREE TESTOSTERONE IN HIRSUTE WOMEN

Objective: To determine the serum levels of androstanediol glucuronide (3 alpha-diol G), total T, and free T in hirsute and nonhirsute women.Design: Controlled clinical study.Patients: Hirsute women with oligomenorrhea, hirsute women with regular ovulatory cycles, and nonhirsute women with regular cycles were selected.Main Outcome Measure: Serum levels of 3 alpha-diol G, total T, and free T were measured in 8 hirsute with oligomenorrhea and 11 hirsute women with regular ovulatory cycles and compared with 20 nonhirsute women with regular cycles (control group). Serum 3 alpha-diol G was also measured during the follicular, periovulatory, and luteal phases in hirsute women with regular cycles.Results: Serum levels of 3 alpha-diol G did not change during the menstrual cycle, in addition we observed that there was no difference between the levels of 3 alpha-diol G, total T, and free T in hirsute women with regular cycles when compared with normal women. These three serum androgens were elevated only in the hirsute women with oligomenorrhea. Besides, there was better correlation between total T and free T (r = 0.81) than total T and 3 alpha-diol G (r = 0.49) or free T and 3 alpha-diol G (r = 0.66).Conclusion: The findings suggest that serum 3 alpha-diol G does not provide additional benefit as a marker of hirsutism than serum total or free T.ESCOLA PAULISTA MED,DEPT GYNECOL,RUA JESUINO ARRUDA 666 APTO 53,BR-04532 SAO PAULO,BRAZILESCOLA PAULISTA MED,DEPT GYNECOL,RUA JESUINO ARRUDA 666 APTO 53,BR-04532 SAO PAULO,BRAZILWeb of Scienc

The value of serum levels of dehydroepiandrosterone sulfate as a screening test for late-onset congenital adrenal hyperplasia

Objective: To evaluate the use of serum level of dehydroepiandrosteronesulfate as a screening test for late-onset congenital adrenal hyperplasia.Methods: Fourteen hirsute women with elevated serum levels ofdehydroepiandrosterone sulfate, 17 hirsute women with normal serumlevels of dehydroepiandrosterone sulfate, and 12 non-hirsute ovulatorywomen were selected. Blood samples were collected before and 1hour after the adrenocorticotropic hormone stimulation test. Serumlevels of dehydroepiandrosterone sulfate were measured before theadrenocorticotropic hormone stimulation test. Serum levels of 17-hydroxyprogesterone, compound S, 17-hydroxypregnenolone,dehydroepiandrosterone, androstenedione, and cortisol weremeasured 1 hour after the adrenocorticotropic hormone stimulationtest. Results: Two hirsute women with elevated serum levels ofdehydroepiandrosterone sulfate satisfied the criterion for late-onsetcongenital adrenal hyperplasia due to 21-hydroxylase deficiency, i.e.,a serum level of 17-hydroxyprogesterone after the adrenocorticotropichormone stimulation test >1000 ng/dL. No hirsute woman had 11bhydroxylaseor 3b-hydroxysteroid dehydrogenase deficiency.Conclusions: Serum level of dehydroepiandrosterone sulfate is usefulas a screening test for late-onset congenital adrenal hyperplasia. Anelevated serum level of dehydroepiandrosterone sulfate does notnecessarily mean an adrenal enzymatic defect, whereas a normalvalue excludes the possibility of late-onset congenital adrenalhyperplasia