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Female thyroid cancer: the role of reproductive and hormonal factors in Switzerland.

We conducted a study on 91 women with thyroid cancer and 306 controls in hospital for acute nonneoplastic, non-hormone-related disorders in order to investigate the role of reproductive and hormonal factors in the etiology of epithelial thyroid cancer in the Canton of Vaud, Switzerland. Non-significant increases in cancer risk with an increasing number of full-term pregnancies (odds ratio, OR, after allowance for age and previous benign thyroid disease = 1.6, for > or = 3 vs. 0 full-term pregnancies, 95% confidence interval, CI: 0.7-3.6) and spontaneous abortions (OR = 2.0 for > or = 2 vs. 0 spontaneous abortions, 95% CI: 0.7-5.2) were seen. A significantly elevated OR (2.8, 95% CI: 1.1-7.2) was found in those women whose first pregnancy ended with an abortion. Whereas most other reproductive, menstrual and hormonal factors examined did not seem to affect the risk of thyroid cancer significantly, a clue emerged of an association between thyroid cancer and artificial menopause (OR = 6.3, for women who underwent artificial menopause vs. premenopausal women, 95% CI: 1.7-23.2). Although not necessarily causal, the relationship between the risk of epithelial thyroid cancer and the occurrence of spontaneous abortions and artificial menopause deserves attention in future studies, in the light of the high incidence of thyroid cancer in young and middle-aged women.

Abortion, Spontaneous↗

[Chromosomal abnormalities in male gametes].

Most of the human chromosomal abnormalities seems to be of a germ-cell origin. Human oocytes are difficult to obtain and to handle, so most of the studies has been performed on male gametes. Genetic status of spermatozoa may be critical for human reproduction as well as wellbeing of fetus. The ability to identify and to characterize chromosomal aberrations in human sperm would lead to understanding of the mechanism causing chromosomal abnormalities and to approach possible preventive strategies. The aim of this paper was to present current data concerning the chromosomal aberations in human spermatozoa. Presented overview strongly underlines the importance of genetic investigations of male gametes.

Adult↗

Fetal syndromes and the charter: the Winnipeg glue-sniffing case.

The relationship between scientific knowledge and legal discourse is raised once again by a recent decision of the Supreme Court of Canada, a case involving a young Aboriginal woman who was pregnant and ordered by the court to remain in a drug treatment program at a health center until the baby was born. Her glue-sniffing habit was deemed dangerous to the normal development of the fetus. The Court held that her solvent-dependency did not justify the original court action, but both the Court and the various interveners disregarded the current state of our knowledge on the fetal syndromes. There is thus a continuing disconnect between the scientific understanding of fetal risk and the development of Constitutional law around women's reproductive rights. This paper reviews the case and follows it through the appellate process; we examine the research literature on fetal syndromes tracking the changes over time. Finally we comment on the interventions by the Winnipeg Child and Family Services, the Women's Health Rights Coalition, by The Canadian Civil Liberties Association, and both The Canadian Abortion Rights Action League and the Women's Legal Education and Action Fund.

Adult↗

[Development of the reproductive system in the progeny of rats with streptozotocin diabetes].

Specificities of functioning and development of the reproductive system and mechanism of its regulation with hypothalamic structures were studied in the progeny of rats with streptozotocin diabetes. For this purpose pituitary sensitivity was analyzed in mature animals, as was functional capacity of the feedback system mediating the hypothalamic regulation of gonadotropin secretion in rat males and females at the age when this system normally starts functioning in health. The hypothalamo-hypophyseo-gonadal system feedback mechanism was found to develop in the progeny of female rats with streptozotocin diabetes later than in health. Pituitary sensitivity to LH-RH was reduced and LH level reduced by 1.5 times in mature progeny of rats with streptozotocin diabetes as compared to that in the progeny of healthy rats. These results permit a conclusion that the progeny of rats with streptozotocin diabetes develop disorders in the mechanism regulating the reproductive system of the body, though not so grave as to make this system functioning impossible.

Animals↗

Polycystic ovaries are common in women with hyperandrogenic chronic anovulation but do not predict metabolic or reproductive phenotype.

Polycystic ovary syndrome (PCOS) is a heterogeneous disorder of unexplained hyperandrogenic chronic anovulation. Experts have recommended including the morphology and volume of the ovary in the diagnostic criteria for PCOS. We performed this study to determine whether there was an association between the morphology and size of the ovaries and markers of insulin sensitivity as determined by dynamic testing within women with PCOS or compared with a group of control women. We then examined reproductive parameters. We studied 88 unrelated PCOS women and 21 control women, aged 17-45 yr. All were in the early follicular phase or its equivalent (no follicle with > 10 mm diameter and anovulatory serum progesterone level < 3 ng/ml). Subjects underwent on the same day a phlebotomy for baseline hormones, a 2-h oral glucose tolerance test, and transvaginal ultrasound to determine the morphology and volume of the ovaries. Ninety-five percent (84 of 88) of women with PCOS and 48% (10 of 21) of the control women had polycystic ovaries using the criteria of at least one ovary greater than 10 cm3 (PCOV) and/or polycystic ovary morphology (PCOM) using the criteria of 10 or more peripheral follicular cysts 8 mm in diameter or less in one plane along with increased central ovarian stroma. PCOM was a better discriminator than PCOV between PCOS and control women. The odds of women with PCOS having PCOM were elevated 50-fold compared with controls (odds ratio, 50; 95% confidence interval, 10-240; P < 0.0001), whereas the odds of PCOV were elevated 5-fold in women with PCOS (odds ratio, 4.6; 95% confidence interval, 1.7-12.6; P = 0.003). Neither the insulin sensitivity index, fasting or 2-h values, or any integrated measures of glucose and insulin varied in women according to either morphology or volume, nor was there an association with circulating androgen levels. Women with PCOS and PCOM had lower FSH levels than women with PCOS and non-PCOM. Women with PCOS and PCOV had a higher LH to FSH ratio than women without PCOV and PCOS. These data support the hypothesis that polycystic ovaries are an abnormal finding. However, neither the morphology nor the volume of the ovaries is associated with distinctive metabolic or reproductive phenotypes in women with PCOS.

Adolescent↗

Autoimmune disease in pregnancy.

Autoimmunity, whether present in a recognized syndrome such as systemic lupus erythematosus or represented by the production of subclasses of autoantibodies, adversely affects reproduction. While fertility of patients with autoimmune disorders is generally unimpaired, important exceptions exist. Recent data regarding the impact of intercurrent pregnancy upon women with SLE suggest that the overall course of this disorder is not affected. The impact of SLE and related autoimmune phenomena during pregnancy primarily relates to adverse fetal outcome. Pregnancy wastage is excessive, and premature delivery and poor fetal growth are commonly encountered. The occurrence of fetal complications correlates with the level of maternal disease activity and the presence of specific autoantibodies. Management of pregnancy complicated by SLE or the production of autoantibodies associated with poor reproductive outcome should be directed at maintaining maternal disease quiescence. The adverse effect of the maternal disorder on fetal growth and development far outweighs actual or theoretical risks attributable to maternal drug therapy.

Autoimmune Diseases↗

[Rational hormonal diagnosis of oligomenorrhea].

In a study, conducted by two clinics in Berlin and Hamburg, specializing in reproductive endocrinology, the anamnestic, clinical, and laboratory data of 170 oligomenorrheic patients (menstrual intervals between 35 and 90 days) were evaluated in order to determine the frequency of possible causes of oligomenorrhea. Pathological hormone levels were found in two thirds of all patients. The order of frequency of abnormal hormone levels was as follows: hyperandrogenemia (testosterone and/or DHEA-sulfate) in 41.8%, hyperprolactinemia in 25.9%, abnormal thyroid function (TSH and/or TRH-induced TSH) in 21.7%, and hypergonadotropic FSH levels in 3.5% of all patients. There was an overlap of between two or more pathological conditions in one third of all patients. This study confirms results of a previous study in amenorrheic patients (Moltz et al., 1987 - see reference list), documenting hyperandrogenemia as the most frequent abnormality found in this group, followed by hyperprolactinemia. As can be expected, the percentage of women with no discernible abnormality was higher in oligomenorrheic patients when compared with the amenorrheic group (32.3% vs 7.7%). Furthermore, overweight patients were overrepresented in the oligomenorrheic group, while underweight patients were seen more frequently in the amenorrheic group. In view of these results of our study we recommend a detailed diagnostic follow-up in all younger patients with ovarian disorders who need to preserve their reproductive potential. This follow-up should include hyperprolactinemia, hypo-/hyperthyroidism, hyperandrogenemic and hypoestrogenemic states and exclusion of primary ovarian failure. In contrast to recommendations of WHO, issued in 1976, such diagnostic work allows an etiology oriented therapy decision and a therapy risk assessment in subgroups of patients, such as hyperandrogenemic patients, who receive clomiphene or gonadotropin treatment. Furthermore, it permits prophylactic considerations, for prevention of hirsutism and polycystic ovarian disease, struma and osteoporosis prophylaxis.

Adolescent↗

Ectopic pregnancy: 'classic' vs common presentation.

Ectopic pregnancies are common, are increasing in incidence, and are preventable causes of reproductive morbidity and death. They are also frequently misdiagnosed, and are one of the most common causes for malpractice claims made against primary care physicians. The classic description of the presenting signs and symptoms of ectopic pregnancy was derived from a series of ruptured ectopic pregnancies. To decrease the complications and preserve fertility, ectopic pregnancies must be detected before they cause tubal rupture. A family medicine center experience with the diagnosis of ectopic pregnancy over a six-month period is presented. The study confirmed the expected frequency of this condition in this population but findings disclosed that the classic presentation was, in fact, uncommon. Implications for decision making derived from these case reports are discussed. A high level of clinical suspicion for this problem must be maintained.

Abdomen↗

Gonadal steroid regulation of mood: the lessons of premenstrual syndrome.

New models for menstrual cycle-related mood disorders provide unique opportunities to gain insight into the processing of emotional information and the regulation of mood state by reproductive steroids. This paper reviews the role of reproductive steroids in affect regulation and in premenstrual dysphoric disorder (PMD), parses PMD into component processes that suggest potential mediating neurocircuitry, and highlights the importance of and potential contributors to the differential sensitivity that permits reproductive steroids to destabilize mood in some but not all women.

Adolescent↗

Menorrhagia from a haematologist's point of view. Part II: management.

The management of menorrhagia has until recently been the domain of the gynaecologist. As haematologists, we are now addressing the issue of optimal management of menorrhagia in our patients with bleeding disorders. Addressing three life periods, the menarche, reproductive years, and postchildbearing years, this review will discuss the use of oral contraceptive agents, antifibrinolytics, non-steroidal anti-inflammatory drugs, intranasal DDAVP and the new levonorgestrel-impregnated IUD. Management of specific bleeding disorders will also be reviewed for von Willebrand disease, haemophilia A and B carriers, women with factor XI deficiency and PAI-1 deficiency.

Disease Management↗

Premature ovarian failure associated with autoimmune polyglandular syndrome: pathophysiological mechanisms and future fertility.

BACKGROUND: Autoimmune polyglandular syndromes (APS) are a series of disorders characterized by autoimmunity against two or more endocrine organs. Premature ovarian failure (POF) may also have an autoimmune origin and, when accompanied by other autoimmune endocrinopathies, may be part of the APSs. Onset of autoimmune ovarian failure usually occurs in childhood, adolescence, or adulthood, and as a result, fertility may be severely compromised. CASE REPORT: A 26-year-old women with secondary amenorrhea, Addison's disease, and autoimmune hypothyroidism requested infertility evaluation. Examination, transvaginal ultrasonography, endocrine evaluation, and ovarian biopsy were performed. 21-Hydroxylase and antithyroid antibodies were demonstrated, but ovarian steroid cell antibodies (StCA) were absent at the time of her infertility evaluation. Transvaginal sonography demonstrated only a few ovarian follicles. An ovarian biopsy revealed lymphocytic infiltration of the ovary. This presentation is consistent with APS type II accompanied by autoimmune POF. DISCUSSION: Unlike APS types I and III, autoimmune POF is more commonly encountered with APS types I and III than with APS type II. An autoimmune response to steroidogenic enzymes and ovarian steroid cells appears to mediate destruction of ovarian function. Although immunotherapy with corticosteroids (with or without in vitro fertilization [IVF]) may be successful in limited cases where several follicles are present, oocyte donation with IVF may be the best option for the patient seeking fertility, particularly in the absence of ovarian follicles. CONCLUSIONS: Advances in molecular genetics may be valuable in predicting and counseling women at risk for APS and POF, and cryopreservation of ovarian tissue may offer hope to affected unmarried young women. It is reasonable to suggest that children and reproductive aged women with one autoimmune disorder should be periodically screened for other autoimmune disorders.

Adult↗

Long-term physiological and economic consequences of growth retardation in children and adolescents.

The application of a lifespan perspective in human biology in recent years has shown that a number of early environmental factors influencing human growth and development have long-term biological or psycho-social consequences. Human growth is characterized by prolonged infancy, an extended childhood phase and high rates of growth during the adolescent growth spurt. It is unlikely that these characteristics would have evolved without having advantages, and curtailments have the potential for disadvantage. The present paper examines the evidence for long-term physiological and economic consequences of growth retardation in children and adolescents. The emphasis is the biological and economic imperatives of survival, subsistence, reproduction and production rather than aspects of metabolic competence. Many of the consequences of growth retardation are determined by the direct effect on body size, but many other consequences arise from the conditions that cause the growth retardation. Catch up of retarded growth can occur, but does not usually do so because of the continued presence of the retarding agents. Basal metabolism and physical work capacity are usually commensurate with the size of the individual; mechanical efficiency of physical work is unchanged, but falls in activity levels may occur along with a reduction in the pace of activity. Growth retardation in childhood is associated with a higher disease and mortality risk in adulthood, with decreased productivity and employment and promotion prospects. Studies are showing that relative deprivation and the accumulation of socially patterned exposures are important in some societies. Height and growth retardation have proved invaluable in reflecting these factors, but the next generation of studies may require more discriminating indices.

Adolescent↗

Preeclampsia and human reproduction. An essay of a long term reflection.

Hypertensive disorders of pregnancy (HDP: pregnancy-induced hypertension, preeclampsia, eclampsia) affect approximately 10% of human births. Women are at increased risk for HDP during their first conception; and/or when the conception is with a new partner (new paternity); when conception occurs very shortly after the beginning of their sexual relationship. A primary cause of preeclampsia is the defect of the normal human-specific deep endovascular invasion of trophoblast, which is a consequence of the nutritional demands of growth of the human fetal brain. The occurrence of preeclampsia represents a reproductive disadvantage unique to humans compared with other mammals. As such, it may have played a significant role in shaping human reproduction and, therefore, human sexuality. This deep implantation/preeclampsia phenomenon may explain many anthropological mysteries of human sexuality that do not exist in other mammalian species (and primates). These include: very low fertility rate, concealed ovulation, all year long 'apparent-waste-of-efficiency' sexuality, absence of sperm competition in human females at the time of conception, and the unexplained testicle size in human males compared with relevant primates. Further, this deep trophoblastic implantation (and its failure in preeclampsia) in humans might be a decisive condition of hominization between great apes and all the other Homo genuses. This frontier might even have occurred inside these Homo lineages: because of their relatively small brains, the first species of Homo might not have presented the deep trophoblastic invasion described in Homo sapiens.

Adaptation, Physiological↗