Comparison of norgestrel- versus cyproterone acetate-containing hormone replacement therapy on lipid-lipoprotein metabolism.

To compare the effects on the lipid profile of estradiol valerate with norgestrel to a regimen of estradiol valerate with cyproterone acetate. Sixty-four healthy women in their perimenopause or early postmenopause, aged between 40-55 years, were randomized to one of the two 21-day sequential regimens: estradiol valerate 2 mg/day for 21 days and combined with either norgestrel 0.5 mg/day or cyproterone acetate 1 mg/day from day 12 to 21, with 7 days of drug-free interval, for 12 cycles. Lipid profiles were followed at baseline, 6 and 12 cycles. Sixty-one subjects completed the study, 30 in the norgestrel group and 31 in the cyproterone group. During 12 cycles of study, serum HDL cholesterol levels decreased significantly in the norgestrel group (p < 0.01) and were unchanged in the cyproterone group. The levels were significantly lower in the norgestrel group than in the cyproterone group (p < 0.05). No differences were found between groups as regards LDL cholesterol and total cholesterol levels. Triglyceride levels decreased significantly in the norgestrel group (p < 0.01), remained unchanged in the cyproterone group and the levels were significantly different between groups (p < 0.01). In conclusion, the study demonstrated that sequential regimen of estradiol valerate with norgestrel produced less favorable HDL cholesterol but more favorable triglyceride levels than the regimen of estradiol valerate with cyproterone acetate.

Hirsutismo - tratamento / Treatment of hirsutism

O hirsutismo representa uma patologia de grande importância para os médicos ginecologistas, näo só pela sua expressiva incidência e pelo aspecto emocional que envolve as pacientes, mas também pela baixa aderência ao tratamento que deve ser a longo prazo.

Blockade of the in vitro effects of testosterone and erythropoietin on Cfu-E and Bfu-E proliferation by pretreatment of the donor rats with cyproterone and flutamide

Erythropoietin is obligatory to support the terminal proliferation and differentiation of erythroid cells but it is not the only agent in modulating red cell production. Previously, we have shown that Testosterone enhances erythropoiesis, at least in part, by increasing renal erythropoietin production. Testosterone may also influence directly the behavior of the erythroid progenitor cells increasing erythroid stem cell proliferation. To gain further insight into the role of testosterone in regulation of erythropoiesis and its interactions with erythropoietin, we studied the effect of testosterone and erythropoietin, using clonal cultures of erythropietic progenitors, to observe CFU-E and late and early BFU-E colonies proliferation from bone marrow cells of donor rats pretreated for 2 days with the androgen antagonists cyproterone (10 mg/Kg/day) and flutamide (160 mg/Kg/day). Specific nuclear receptors for testosterone were demonstrated in marrow erythroid cells. Then, erythroid progenitors may come with their androgen receptors blocked by pretreatment. Cultures were prepared using the methylcellulose technique containing a standard dose of erythropoietin (250 mu/ml) or testosterone (10(-7) M). Results obtained demonstrate that testosterone produced a significant stimulation on CFU-E and BFU-E colony formation. A dose effect correlation was apparent. Testosterone enhances proliferation of late BFU-E more than CFU-E and produce only a slight augmentation of early BFU-E. As expected, erythropoietin markedly stimulate all erythroid colony growth, mainly CFU-E. The effects of testosterone were completely abolished in cultures from bone marrow cells of rats pretreated with cyproterone and flutamide. Activation of the specific androgen nuclear receptors in erythroid cells appears to be necessary for testosterone to develop the erythropoietic effect. Surprisingly, the effects of erythropoietin on erythroid colonies proliferation were also completely blocked by pretreatment with flutamide and partially blocked by pretreatment with cyproterone. Right now, we do not have a satisfactory explanation regarding inhibition of the effects of erythropoietin by pretreatment to marrow donor rats with the androgen antagonists. In conclusion, we postulate triggering late BFU-E cells, a marrow erythropoietin responsive cell population, into active cell cycle, as well as by increasing blood erythropoietin concentration.

Therapeutic alternatives for the hirsute woman

A retrospective analysis of 21 hirsute women seen at a gynecological endocrine clinic revealed a high incidence of infertility, menstrual irregulaties and abnormal androgen profile. Polycystic ovarian syndrome (PCOS) was the underlying abnormality in the majority of cases. Cyproterone acetate (CPA) with ethinyl oestradiol in a reverse sequential regime was more effective and better tolerated but much more expensive than the combination of spironolactone and the oral contraceptive pill (OCP).

Efecto antiandrogénico y eficacia contraceptiva de las píldoras combinadas de acetato de ciproterona y etinil estradiol / Antiandrogenic effect and contraceptive effectiveness of combined pills with cyproterone acetate and ethinylestradiol

Se trataron 30 mujeres que presentaban manifestaciones clínicas de hiperandrogenismo, tales como hirsutismo, acné, seborrea o la asociación de ellos. Se les administró una combinación de 2 mg de acetato de ciproterona y 50 *g de etenil estradiol (Diane) del quito al vigésimo quinto días del ciclo menstrual, durante 6 meses. Al finalizar cada ciclo se evaluó el grado de hirsutismo, acné, seborrea y la aparición de efectos indeseables del medicamento. Encontramos una notable mejoría del acné en todas las pacientes y de la seborrea en la mayoría. También se demostraron efectos beneficiosos sobre el hirsutismo en la mayoría, aunque la mejoría no fue tan ostensible. Los efectos desagradables del medicamento fueron mínimos. No se produjo ningún embarazo, por lo que la eficacia contraceptiva fue del 100 %. Se concluye que esta combinación de baja dosis de acetato de ciproteron y etinil estradiol es muy útil en las mujeres con manifestaciones clínicas de hiperandrogenismo que deseen contracepción, pues por sus acciones tienen un doble efecto beneficioso

Puberdade precoce verdadeira idiopática: apresentaçäo e evoluçäo de três casos / Really precocious idiopatic puberty: report and evolution of 3 cases

Os autores apresentam 3 casos de pacientes portadores de puberdade precoce verdadeira, sendo duas meninas e um menino, diagnosticados respectivamente aos 2 anos e 7 meses, 5 anos e 4 meses e 5 anos. Relatam os procedimentos diagnósticos utilizados, tais como dosagens hormonais basais, determinaçöes das idades ósseas e tomografias computadorizadas. Abordam a terapêutica utilizada e os resultados obtidos, enfatizando a regressäo dos caracteres sexuais secundários

Efeito da combinaçäo de acetato de ciproterana e estrógenos conjugados sobre hirsutismo, alopécia e acne / Effect of the combination ciproterone acetate and conjugated estrogens on hirsutism, alopecia and acne

Apresentam-se os resultados do tratamento com acetato de ciproterona e estrógenos conjugados em 45 mulheres com queixas de hirsutismo, acne e alopécia androgênica. A grande maioria (88,6%) apresentou algum grau de resposta ao tratamento, mais evidente nas pacientes com acne, nas quais houve desaparecimento completo dos sintomas em 55% dos casos. Pacientes com hirsutismo e alopécia apresentaram respostas menos expressivas. O tratamento determinou reduçäo significativa nos níveis séricos de androstenediona (A=0) e testosterona (T=0) da ordem de 23% e 34%, respectivamente; näo se verificou correlaçäo nítida entre a melhora clínica e a reduçäo dos níveis séricos de andrógenos. Os efeitos colaterais relatados foram de pequena monta e näo determinaram a suspensäo do tratamento em nenhum caso