Role of progestins with partial antiandrogenic effects.

An experts' meeting on the 'Role of progestins with partial antiandrogenic effects' was held in Berlin from January 19 to 22, 2001. The meeting was chaired by Dr R. Sitruk-Ware (New York, USA) and participants included Ms F. Fruzzetti (Pisa, Italy), J. Hanker (Trier, Germany), J. Huber (Vienna, Austria), F. Husmann (Bad Sassendorf, Germany), S. O. Skouby (Copenhagen, Denmark), J. H. H. Thijssen (Utrecht, The Netherlands), and R. Druckmann (Nice, France). The present paper reports the conclusions of the meeting. However, the publication of the Women's Health Initiative study, which appeared after the meeting, led to additional comments and revisions.

IGF-1 in gynaecology and obstetrics: update 2002.

Recent discoveries on endocrine, paracrine and autocrine involvement of insulin-like growth factor-1 (IGF-1) in the proliferation of many tissues raised the attention of its role in reproduction and in the growth of various cancers as well as of benign proliferations. The intention of this article is to focus on IGF-1 in the field of gynaecology. Perimenopausal women who exhibit high IGF-1 and low IGF binding protein (IGFBP) levels, like IGFBG-3, have an increased risk of developing breast cancer. A higher risk for cervical, ovarian and endometrial cancer is related to high IGF-1 levels in post- and premenopausal women. It has been shown that myomas, by far the most common benign uterine tumor in women, grow in the presence of IGF-1, in vitro as well as in vivo. Studies show that IGF-1 is involved in the differentiation of various reproductive tissues, like endometrium and ovarian tissues. Patients suffering from polycystic ovary syndrome (PCO) frequently show insulin resistance accompanied by an increase of IGF-1 in plasma. Plasma IGF-1 levels are higher in cases of severe endometriosis, however, in endometriosis and in PCO IGF levels locally in the endometrium are reduced, what might explain infertility. Recently, it was shown that IGF facilitates the implantation of the human embryo in the endometrium during IVF. Implantation is a paradox where different immune systems have to collaborate to make implantation and survival of the pregnancy possible. IGF seems to be the starter molecule so that the two epithelia can fuse. A disturbance can result in complications during pregnancy i.e. spontaneous miscarriage, preeclampsia as well as defects of the embryo. Therefore, IGF is a useful marker in successful pregnancy as well. A better mechanistic understanding of IGF-1 action on the cellular level not only provides more elegant mechanistic explanations for the scientist, but the practitioner might find it interesting to utilize its diagnostic potential as a marker for various diseases. The relation between systemic IGF levels and local tissue IGF-1 levels has not yet been determined for all conditions.

Recommendations for estrogen and progestin replacement in the climacteric and postmenopause. European Progestin Club.

The diversity of function that sex steroids have proven to have in the female body, gives them a position of central importance in gynaecology. Scientific research demonstrates not only the well known genital functions of sexual steroids, furthermore, various extragenital organs are influenced and modulated by ovarian hormones. Therefore, the general benefit of HRT for the female organism becomes clearer and the clinical management of menopause is developing to a broad new discipline, the gender specific medicine. In clinical practise, phytosteroids are claimed by the patient and therefore, also of high interest for the scientific research. Also, tissue specificity of the endocrine treatment and the biological relevance of different steroid receptors of HRT are discussed, leading to the development of new HrT preparations. Individualisation, the tailoring of HRT, according to the patients needs, and low dose steroids management, will also become an important aspect in the recommendations for estrogen and progestin replacement therapy.

Aspects of progestin activity on the breast. European Progestin Club.

On 9-11 May 1997, the second Meeting of the European Progestin Club was held in Turin, Italy. Aspects of progestin use on the breast were discussed, based on the currently available scientific data. The paper covers topics addressed at the meeting and summarizes the recommendations which could be agreed on by the participants.

[The role of progestins in puberty and adolescence]. / Die Rolle der Gestagene in der Pubertät und Adoleszenz.

Normal puberty is characterized through an extensive amount of biological manifestations and clinical phenotypes, which develop over a period of two to three years. The clinical maturation process is determined by the beginning of the function of the hypothalamus-pituitary-gonad-axis. Comparable to the situation at the beginning of the climacterium, during the adolescent period often a disturbed balance between estrogen and progesterone can be found in the sense of an ovarian luteal insufficiency with the consequence of a relative progesterone lack. The most evident symptoms in many cases are irregular vaginal bleedings. A careful differential diagnosis is the basis for the differentiation between physiological changes during the pubertal development and pathologies. Some disturbances resulting from luteal deficiency may lead to serious consequences like impairment of fertility or diseases of the mammary gland, especially if they exist untreated over a longer period. Therefore early and adequate treatment with a suitable progestin is of great importance for the further destiny of the patient. Furthermore, the multitude of differential partial effects amongst the available progestins require a differentiated choice of the right one.

[Radiography used during operations for biopsies of non-palpable lesions of the breast which have been suspected because of mammography (author's transl)]. / Radiographie per-opératoire de biopsie des lésions du sein non palpables suspectes à la mammographie.

In order to prove that non-palpable lesions of the breast that have been removed after suspicion from mammography have been removed completely it is appropriate to X-ray during the operation of biopsy in order to make a diagnosis. Tests carried out with the X Faxitron X-ray apparatus on 369 patients show that even X-ray departments that carry out mammography and do not have specialised equipment can with quite modest means use this reliable technique for diagnosis.