Effect of intramuscular triamcinolone acetonide on the human ovulatory cycle.

The effect of intramuscular triamcinolone acetonide (TCA-A) on pituitary gonadotropins and ovarian hormones was studied in a normally menstruating woman. Serum levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well estradiol 17-beta (E2) and progesterone (P), were determined daily in a normal "ovulatory" pretreatment cycle. A total of 160 mg of TCA-A was then administered in four injections over two and a half months. Daily serum levels of LH, FHS, E2, and P were again measured during a period beginning thirty days after the last injection of TCA-A. Cyclicity of all these hormones was absent after treatment. Both LH and FSH were suppressed in the first half of the post-treatment period when compared with the pretreatment ovulatory cycle. A potent corticosteroid such as TCA-A is apparently capable of producing anovulatory cycles in humans by disruption of cyclic pituitary gonadotropin secretion.

PIP: The effect of triamcinolone acetonide (TCA-A) im on pituitary gonadotropins and ovarian hormones was studied in a normally menstruating woman. Serum levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), as well as estradiol-17beta (E2) and progesterone (P), were determined daily in a normal "ovulatory" pretreatment cycle. A total of 160 mg of TCA-A was then administered in 4 injections over 2 months. Daily serum levels of LH, FSH, E2, and P were again measured during a period beginning 30 days after the last injection of TCA-A. Cyclicity of all these hormones was absent after treatment. Both LH and FSH were suppressed in the 1st half of the posttreatment period when compared with the pretreatment ovulatory cycle. A potent corticosteroid such as TCA-A is apparently capable of producing anovulatory cycles in humans by disruption of cyclic pituitary gonadotropin secretion.

Erythroplasia of Queyrat: treatment with topical 5-fluorouracil.

Seven adult men with biopsy-confirmed erythroplasia of Queyrat (EQ) were cured of their disease with topically applied 5-fluorouracil (5-FU) under occlusion. Post-treatment biopsy specimens revealed normal histologic findings and recurrence-free follow-up periods extended up to 70 months. It is suggested that topical 5-FU is the treatment of choice for histologically confirmed EQ because of its superior results compared with thoseof surgery or radiation therapy. Our view is corroborated by several single case reports of EQ similarly treated.

Topical 5-fluorouracil in the treatment of carcinoma in situ of the vulva.

The clinical and pathologic response of carcinoma in situ of the vulva in a 42-year-old woman treated with topical 5-fluorouracil is reported. Except for one persistent area of involvement in the anal region which required local excision, the result of treatment was excellent, with no evidence of recurrence after 2 years' followup. This important adjunct in the treatment of intra-epithelial carcinoma deserves long-range investigation.

Long-term intramuscular administration of triamcinolone acetonide. Effect on the hypothalamic-pituitary-adrenal axis.

Five patients received intramuscular injections of triamcinolone acetonide for periods ranging from five months to three years. Metyrapone tartrate testing was used to assess the function of the hypothalamic-pituitary-adrenal (HPA) axis during, after, and, in one case, before the drug therapy. The HPA axis function was found to be suppressed during the period of treatment and up to ten months after cessation of therapy. Lens opacities appeared in two of the five patients while they were receiving triamcinolone acetonide. Results of this study indicate that patients to whom triamcinolone acetonide has been administered should be given supportive doses of corticosteroids during stressful situations (eg, major surgery). They should also receive ophthalmologic examinations every three to six months while they are receiving the medication.