Hormonal regulation of menstrual function in patients of reproductive age with acromegaly

Background: The frequency of menstrual disorders in patients with acromegaly is 40–84% and are caused by three main reasons – the development of normal or hypogonadotropic hypogonadism due to hyperprolactinemia or a mass effect of the tumor and direct effects of GH and IGF-1 on the reproductive system. Nevertheless the exact mechanisms of reproductive dysfunction are not clear now. Hypothalamic structures play significant role in the regulation of hypothalamic-pituitary-ovary axis, so it’s important to study key neuropeptides and evaluate their effects to the pathogenesis of ovarian dysfunction during excessive secretion of growth hormone. Aim: The aim of the work is to study the hormonal regulation of menstrual function in patients of reproductive age with acromegaly in the active stage of the disease. Material and methods: The study included patients with a confirmed diagnosis of acromegaly and healthy women, comparable in age and BMI. Blood serum samples were taken in the morning (8–9 hours) on an empty stomach for 3–5 days of the menstrual cycle or on any day with amenorrhea and frozen at -70°C. The hormonal study was carried out by an enzyme immunoassay, in the case of a kisspeptin, with the preliminary extraction of serum samples. Results: The study included 31 patients with acromegaly and 15 healthy women. Between groups there was a statistically significant decrease in levels of LH (p = 0.001), FSH (p = 0.09), inhibin B (p = 0.003), and kisspeptin (p = 0.00005). The frequency of hyperprolactinemia in the cohort of patients was 51.6%. During the correlation analysis, a negative dependence of kisspeptin on the levels of GH and IGF-1 was detected (r = -0.54, p = 0.002 and r = -0.63, p = 0.0002). Conclusions: The severity of the central depression of regulation of menstrual function in patients with acromegaly may be due to the degree of disease activity

Cover letter

Acromegaly is a neuroendocrine disorder with multiple comorbidities. In this article, we present a patient with long-term active acromegaly, without clinical remission after repeated neurosurgery and long-term treatment with somatostatin analogue. After the first neurosurgical treatment, cyclic ovarian function improved. Taken together with progressing metabolic disorders, it led to clinical manifestation of adenomyosis, which presented by algomenorrhea, menometrorrhagia and severe anemia. Due to clinical manifestation and extent of the disease, the patient underwent hysterectomy. Histologically we observed adenomyosis II with 2/3 myometrialpenetration. This clinical case highlights the importance of gynecological assessment among patients with acromegaly of late reproductive and premenopausal period

Pathogenic relations between metabolic and gynecologic disorders in acromegaly: a clinical case report

Acromegaly is a neuroendocrine disorder with multiple comorbidities. In this article, we present a patient with long-term active acromegaly, without clinical remission after repeated neurosurgery and long-term treatment with somatostatin analogue. After the first neurosurgical treatment, cyclic ovarian function improved. Taken together with progressing metabolic disorders, it led to clinical manifestation of adenomyosis, which presented by algomenorrhea, menometrorrhagia and severe anemia. Due to clinical manifestation and extent of the disease, the patient underwent hysterectomy. Histologically we observed adenomyosis II with 2/3 myometrialpenetration. This clinical case highlights the importance of gynecological assessment among patients with acromegaly of late reproductive and premenopausal period

The role of intrа- and postoperative ACTH and cortisol levels measurement in patients with Cushing’s disease as an early predictors of remission

Objectives. The aim of this research was to study the dynamic changes of intra- and early postoperative hormonal parameters (ACTH and cortisol) as predictors of hypercorticism remission. Material and methods. 50 patients with confirmed Cushing`s disease (CD) were sampled for this research. The patients were divided into 3 groups depending on the outcome of the operation. The first group patients with secondary adrenal insufficiency confirmed by clinical picture and the level of cortisol less than 50 nmol/l; the second group with normalization of levels of ACTH and cortisol; the third with the persistence of the CD. The results of intraoperative studies during the transnasal adenomectomy were then studied. The group sample consisted of 38 women and 12 men, aged 1566 years. To assess the levels of ACTH and cortisol blood sampling was performed from a peripheral vein. The first sample was taken during the incision of the Dura mater, the second immediately after removal of the tumor and the last 20 minutes after the removal of the adenoma. Then, 1 day after the surgery the hormones mentioned above were studied in all patients. The levels of ACTH and cortisol were measured by immunochemiluminescent analysis on the automated system Cobas 6000 (Roche, France). Reference intervals ACTH 030 ng/ml, cortisol123626 nmol/l. Results. The analysis of the obtained data did not suggest a relationship between the changes of intraoperative indicators of hormonal status and the likelihood of disease remission (p 0.125). In the postoperative period, of the 50 patients, 41 (82%) developed adrenal insufficiency, 5 (10%) showed normalization and in 4 patients (8%) adrenal insufficiency was not observed. The results of the hormonal research after 1 day had a correlation with the frequency of postoperative remission (p 0.125). Conclusion. Intraoperative measurement of levels of ACTH and cortisol is not appropriate and cannot serve as guidance for further tactics of the surgeon to define the totality of tumor removal