Changes in normal lipid profile of menopausal women with combined hormone replacement therapy. Comparative clinical trial of two hormonal combinations (conjugated estrogens/medroxyprogesterone acetate versus estradiol valerate/cyproterone acetate)

Effects of the Pituitary-targeted Gland Axes on Hepatic Lipid Homeostasis in Endocrine-associated Fatty Liver Disease-A Concept Worth Revisiting

Hepatic lipid homeostasis is not only essential for maintaining normal cellular and systemic metabolic function but is also closely related to the steatosis of the liver. The controversy over the nomenclature of non-alcoholic fatty liver disease (NAFLD) in the past three years has once again sparked in-depth discussions on the pathogenesis of this disease and its impact on systemic metabolism. Pituitary-targeted gland axes (PTGA), an important hormone-regulating system, are indispensable in lipid homeostasis. This review focuses on the roles of thyroid hormones, adrenal hormones, sex hormones, and their receptors in hepatic lipid homeostasis, and summarizes recent research on pituitary target gland axes-related drugs regulating hepatic lipid metabolism. It also calls on researchers and clinicians to recognize the concept of endocrine-associated fatty liver disease (EAFLD) and to re-examine human lipid metabolism from the macroscopic perspective of homeostatic balance.

Exploiting steroid-cyclodextrin complexes for selective determination of Estradiol Valerate and Norethisterone Acetate by synchronous fluorescence spectrofluorimetry

Inclusion complexes of β-cyclodextrin with Estradiol valerate (EST) or Norethisterone acetate (NOR) have been utilized for synchronous fluorescence spectrofluorimetry. β-cyclodextrin improves fluorescence intensity as well as water solubility of the studied drugs. Samples in aqueous medium adjusted with ammonia were used in synchronous fluorescence to resolve the overlapped emission spectra. The effects of β-cyclodextrin concentration and Δ λ have been optimized for sensitive and selective analysis of EST and NOR binary mixture. Synchronous fluorescence intensity of the two drugs is measured at Δ λ of 70 nm. EST and NOR can be simultaneously determined at 230 nm and 270 nm, respectively. Calibration curves were linear over the ranges of 0.5-6.0 μg mL^-1 and 0.2-2.0 μg mL^-1 for EST and NOR, respectively. Official guidelines were followed to estimate the validation parameters of the proposed method. The detection limits were 0.08 μg mL^-1 for EST and 0.007 μg mL^-1 for NOR. The proposed method was successfully used for the analysis of EST and NOR in their commercial preparations and the obtained results revealed statistical agreement with those obtained by application of the reported method for both drugs. The proposed method is compared favorably to previously published method in terms of simplicity and hazardous solvent consumption.

Age of Postmenopause Women: Effect of Soy Isoflavone in Lipoprotein and Inflammation Markers

Objectives

Menopause is associated with adverse metabolic changes in plasma lipoprotein and inflammation markers. Estrogens have beneficial effects on lipid metabolism and inflammation. Isoflavones (ISO) have structurally similar to estradiol. Our objective was analize the effect of soy-ISO on serum lipid and inflammatory markers (sP-selectin and sCD40L) in postmenopausal women.

Methods

A 12-week randomized, double-blind, placebo-controlled intervention with soy-ISO (50 mg, twice daily) was conducted in 35 healthy postmenopausal women (55-72 years old). The women were divided in 2 groups: 20 were allocated to soy-ISO, and 15 to a placebo group.

Results

The changes of total cholesterol (TC), triglycerides, low-density lipoproteins-cholesterol (LDL-C), high-density lipoprotein-cholesterol, Apo-A1, sP-selectin and sCD40L in 2 groups before and after 12-week treatment showed no statistical significance. In subgroup analysis, soy-ISO supplementation significantly decreased the levels of TC, LDL-C and sCD40L in women under 65 years old, and with null effects on serum lipid and inflammation markers in women over 65 years old.

Conclusions

Soy-ISO did not significantly favorable effects on the lipid profile and inflammatory markers in postmenopausal women. However, in women under 65 years of age, soy-ISO significantly decreased the TC, LDL-C and sCD40L, whereas, no effects on lipid profile and inflammation markers in women over 65 years old were observed.

Pharmacology of estrogens and progestogens: influence of different routes of administration

This review comprises the pharmacokinetics and pharmacodynamics of natural and synthetic estrogens and progestogens used in contraception and therapy, with special consideration of hormone replacement therapy. The paper describes the mechanisms of action, the relation between structure and hormonal activity, differences in hormonal pattern and potency, peculiarities in the properties of certain steroids, tissue-specific effects, and the metabolism of the available estrogens and progestogens. The influence of the route of administration on pharmacokinetics, hormonal activity and metabolism is presented, and the effects of oral and transdermal treatment with estrogens on tissues, clinical and serum parameters are compared. The effects of oral, transdermal (patch and gel), intranasal, sublingual, buccal, vaginal, subcutaneous and intramuscular administration of estrogens, as well as of oral, vaginal, transdermal, intranasal, buccal, intramuscular and intrauterine application of progestogens are discussed. The various types of progestogens, their receptor interaction, hormonal pattern and the hormonal activity of certain metabolites are described in detail. The structural formulae, serum concentrations, binding affinities to steroid receptors and serum binding globulins, and the relative potencies of the available estrogens and progestins are presented. Differences in the tissue-specific effects of the various compounds and regimens and their potential implications with the risks and benefits of hormone replacement therapy are discussed.

Effects of estro-progestagens on lipid and hormonal profiles in women with premature primary ovarian failure

Introduction Premature primary ovarian failure (PPOF) is defined as cessation of menstruation before the age of 40, Women with PPOF have hypergonadotropic amenorrhea and hypoestrogenia. The incidence of PPOF is 0.9-3%, and its etiology is midtifactorial (genetic, enzyme deficit, virus infections, autoimmune diseases and idiopathic). PPOF is an independent risk factor for cardiovascular diseases. Untreated women are at higher risk for coronary disease, due to increase of total cholesterol, LDL, triglycerides and decrease of HDL. The aim of this investigation was to study effects of estro-progestagens on lipid and hormonal profiles in PPOF.: Material and methods. This study included: 30 healthy women aged 41 ?2.3 years; body mass index 25?3.2 kg; hip/waist ratio 0.76?0.04; amenorrheic for three years on average. Blood samples were taken for glycemia, cholesterol, HDL, LDL, FSH, LH, prolactin, estradiol, and progesterone measurement at 8 am, before and during the therapy with Trisequens. Hormone analysis: radioimmunoassay (PJA) (INEP, Zemun). Statistics: T-test and linear correlation. Results. Total cholesterol, HDL and LDL have decreased, while prolactin, estradiol and progesterone have increased significantly. Discussion. Women receiving hormone replacement therapy (HRT) have reported reduced mortality and morbidity (30% to 50%) and risk for coronary diseases (61%). Neither has Gaspard's study, nor has ours, found changes in concentrations of triglycerides due to higher synthesis of insulin and higher insulin sensitivity. However, 19-nortestosterone, in some studies, decreases HDL significantly. In our study, the decrease of HDL was not significant, because subjects were younger, with normal BMI. Women with PPOF have to start hormone therapy immediately, in order to prevent cardiovascular diseases, osteoporosis, depression, etc. and to improve their quality of life. .

Cyproterone acetate could counteract the benefits of estradiol valerate in oophorectomized cholesterol-fed rabbits

OBJECTIVE

The administration of hormonal replacement treatment to women with an intact uterus needs to be supplemented with progestogenic compounds to avoid endometrial hyperplasia. However, progestins may cancel the beneficial effects of estrogens on the cardiovascular system. The goal of this study was to examine the effects of adding cyproterone acetate to estradiol (E(2))on aorta atherogenesis.

DESIGN

Thirty-two cholesterol-fed New Zealand white rabbits were studied for 4 months. The animals underwent laparotomy and were randomly allocated to four groups. Twenty-four rabbits underwent bilateral ovariectomy, and the other eight were sham-operated (group S). The ovariectomized rabbits were allocated to three groups of eight animals each receiving E(2) valerate (group E), E(2) valerate plus cyproterone acetate (group EC), or placebo after sterilization (group C).

RESULTS

After 4 months, the cholesterol-rich diet caused atherosclerotic aortic lesions in both treated groups that affected 17.91% +/- 10.19% and 28.16% +/- 7.97% of the aortic surface of groups E and EC, respectively, with a markedly lower aortic plaque size in group E than in groups C and S. Rabbits from group E (but not from group EC) had aortic cholesterol content significantly lower than rabbits from the sham-operated and control groups.

CONCLUSION

E(2) valerate reduces aortic atheromatosis in cholesterol-fed, ovariectomized rabbits, and the addition of cyproterone acetate may neutralize this effect.

Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974-2000

OBJECTIVE

To establish reference estimates of the effects of different hormone replacement therapy (HRT) regimens on lipid and lipoprotein levels.

DESIGN

Review and pooled analysis of prospective studies published up until the year 2000.

SETTING

Clinical trials centers, hospitals, menopause clinics.

PATIENT(S)

Healthy postmenopausal women.

INTERVENTION(S)

Estrogen alone, estrogen plus progestogen, tibolone, or raloxifene in the treatment of menopausal symptoms.

MAIN OUTCOME MEASURE(S)

Serum high- and low-density lipoprotein (HDL and LDL) cholesterol, total cholesterol, triglycerides, and lipoprotein (a).

RESULT(S)

Two-hundred forty-eight studies provided information on the effects of 42 different HRT regimens. All estrogen alone regimens raised HDL cholesterol and lowered LDL and total cholesterol. Oral estrogens raised triglycerides. Transdermal estradiol 17-beta lowered triglycerides. Progestogens had little effect on estrogen-induced reductions in LDL and total cholesterol. Estrogen-induced increases in HDL and triglycerides were opposed according to type of progestogen, in the order from least to greatest effect: dydrogesterone and medrogestone, progesterone, cyproterone acetate, medroxyprogesterone acetate, transdermal norethindrone acetate, norgestrel, and oral norethindrone acetate. Tibolone decreased HDL cholesterol and triglyceride levels. Raloxifene reduced LDL cholesterol levels. In 41 studies of 20 different formulations, HRT generally lowered lipoprotein (a).

CONCLUSION(S)

Route of estrogen administration and type of progestogen determined differential effects of HRT on lipid and lipoprotein levels. Future work will focus on the interpretation of the clinical significance of these changes.