Similarity of female central (hypogonadotropic) hypogonadism and postmenopause

Hypogonadism as a consequence of craniopharyngioma in female patients: comparison of childhood and adult onset and effects of estrogen replacement therapy

PURPOSE

(1) to compare clinical, biochemical features in female patients with hypoestrogenism due to childhood- and adult-onset CP; (2) to reveal effects of estrogen replacement therapy in female patients with childhood-onset CP.

METHODS

Thirty-seven women that received specific treatment for CP in the period from 1980 to 2019 were recruited: 21 with childhood-onset and 16 with adult-onset CP. Clinical and hormonal characteristics were evaluated. Seventeen-beta-estradiol 2 mg and dydrogesterone 10 mg in sequential regiment was used in 18 childhood-onset cases. Mean follow-up was 31 months.

RESULTS

Amenorrheic women with childhood- and adult-onset CP presented with the same complaints except for lack of genital hair and breast hypoplasia, which were common in patients with childhood-onset CP. BMI was lower in childhood-onset CP group, as was the proportion of overweight patients. They had more favorable lipid profile. The levels of estradiol, testosterone and DHEA-S were low and did not differ. Uterine and ovary volumes were reduced in all patients, but the decline was noticeable in the childhood-onset group. Mineral bone density of lumbar vertebrae was diminished in childhood-onset group. Estrogen therapy in these patients led to clinical improvement: increase in BMD in lumbar spine without negative changes in BMI and/or lipid profile.

CONCLUSIONS

Study showed that women with childhood-onset CP had less negative metabolic changes. However, they have more pronounced breast and uterus hypoplasia and lower BMD in lumbar spine. The estrogen replacement therapy led to clinical improvement and BMD increase in lumbar spine without increase of BMI and/or lipid profile changes.

Effects on the Hypothalamo-Pituitary Axis in Patients with CNS or Head and Neck Tumors following Radiotherapy

BACKGROUND

Knowledge about the precise effects of radiotherapy on hypothalamo-pituitary functions is limited. Reduction of side effects is a major goal of advanced radiotherapy modalities. We assessed strategies for monitoring and replacement of hormone deficiencies in irradiated patients.

METHODS

A search strategy was systematically conducted on PubMed®. Additional articles were retrieved to describe endocrine mechanisms.

RESULTS

45 studies were evaluated from 2000 to 2022. They were predominantly retrospective and highly heterogeneous concerning patient numbers, tumor types, radiotherapy technique and follow-up. Endocrine deficiencies occurred in about 40% of patients within a median follow-up of 5.6 years without a clear difference between radiotherapy modalities. Somatotropic and thyrotropic axes were, respectively, the most and least radiosensitive.

CONCLUSIONS

Current pituitary gland dose constraints may underestimate radiation-induced endocrine deficiencies, thus impairing quality of life. Little difference might be expected between radiation techniques for PG tumors. For non-PG tumors, dose constraints should be applied more systematically.

[Abnormal gut microbiota-induced hypoestrogenemia as a possible risk factor for malignancy in endometrioid heterotopia]

This paper reveals the pathogenetic impact of the abnormal gut microbiota on the development of female reproductive system diseases. A dynamic imbalance between the altered microbiota and the macroorganism has many manifestations as hormonal homeostatic disorders, one of which is dysbiosis-induced hypoestrogenemia. Using endometrioid heterotopia as an example, the authors trace the possibility of its progression and malignancy due to the occurrence of primary breakdown of the PTEN tumor-suppressor gene with subsequent genetic abnormalities in the ARID1A and TP53 genes. PTEN mutation in both endometriosis itself and its malignancy indicates that dysbiosis-induced hypoestrogenemia may be implicated in the pathogenesis of endometriosis. Thus, the relationship between female reproductive system diseases and gut microbiome disorders may be more significant; and the possibility of correcting the gut microbiota with prebiotics and probiotics opens new horizons not only in the prevention, but also in the treatment of many gynecological diseases associated with hormone disorders.