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The case of 17 year old girl with coeliac disease and menstruation disturbances was described. The patient began to menstruate regularly at the age of 15 during gluten-free diet. After the change to gluten diet bleedings occurred every 10 days. When she again went on free-gluten diet regular menstruations came back. These disturbances may be connected with introducing gluten to the diet.
Both hyper- and hypothyroidism may result in menstrual disturbances. In hyperthyroidism, amenorrhea was described as early as 1840 by von Basedow. The most common manifestation is simple oligomenorrhea (decreased menstrual flow). Anovulatory cycles are very common. Increased bleeding may occur, but is rare in hyperthyroidism. Nowadays hyperthyroidism is diagnosed earlier than it once was, and so the clinical picture is generally milder. So, menstrual disorders are less common than in previous series. In a recent paper, 21.5% of 214 patients had disturbances in their cycle, compared to 50% in some older series. In hypothyroidism, on the contrary, polymenorrhea (increased menstrual bleeding) is more common. Defects in hemostasis may contribute to this. Anovulation may be represent. Fertility is reduced in both hyper- and hypothyroidism, and the outcome of pregnancy is more often abnormal than in euthyroid women. It is of interest that in juvenile hypothyroidism precocious puberty has been described. This is probably due to a "spillover" effect of the glucoprotein hormones: TSH, which is markedly increased in hypothyroidism, has a small FSH- and LH-like effect. Galactorrhea may also be present in hypothyroidism, possibly because TSH, the hypophyseal TSH-releasing hormone, increases the secretion of both TSH and PRL.
OBJECTIVES: Most thyroid textbooks describe hypothyroidism resulting in changes in the length of the menstrual cycle and in the amount of bleeding. Our experience at a busy thyroid clinic had given a picture which differs from that presented in the literature. The aim of this study was to determine the frequency and type of menstrual irregularities in premenopausal hypothyroid patients. DESIGN AND PATIENTS: We investigated the menstrual history, starting 6 months before the discovery of the disease, in 171 female premenopausal hypothyroid patients and 214 normal controls, with similar age and body mass index (BMI). MEASUREMENTS: TSH, TT4, TT3 and thyroid antibodies were measured by radioimmunoassay, while BMI was calculated from the ratio of body weight in kg to height in m2. RESULTS: Of the 171 hypothyroid patients, 131 (76.6%) had regular cycles and 40 (23.4%) irregular periods. Oligomenorrhoea and menorrhagia were the most common features in the latter group. No difference in BMI was found between the patients with or without menstrual abnormalities, or between patients and controls. TSH, TT4 and TT3 levels did not differ between patients with normal and abnormal menstruation. Forty-six (26.9%) out of 171 patients had subclinical hypothyroidism (group A), 42 (24.6%) mild hypothyroidism (group B) and 83 (48.5%) severe hypothyroidism (group C). Thirty-seven from group A (80.4%), 32 from group B (76.2%) and 62 from group C (74.7%) had normal periods. These differences were not statistically significant. Eighty-eight (88.9%) out of 99 patients in whom thyroid antibodies were measured had positive titres. Nineteen (21.6%) of the patients with positive thyroid antibodies had menstrual irregularities. This percentage did not differ from that found in the whole group of patients (23.4%). Out of 214 normal controls, 196 (91.6%) had normal menstruation and 19 (8.4%) irregular cycles. The latter group included mainly women with oligomenorrhoea. CONCLUSIONS: These data demonstrate that hypothyroidism in women is less frequently associated with menstrual disturbance than was previously described. Also, menstrual irregularities tend to be more frequent in sever hypothyroidism in comparison with mild cases, although this finding was not statistically significant. Oligomenorrhoea and menorrhagia are the most common menstrual disturbances.
OBJECTIVE: Bone loss occurs in young women who experience amenorrhea or ovulatory disturbances. The purpose of this study was to determine whether bone loss could be prevented by simulating a more normal hormonal pattern, using treatment with cyclic medroxyprogesterone, with or without calcium supplementation, in physically active women with disturbed menstruation. DESIGN: This study was a 1-year randomized, double-blind, placebo-controlled trial. Women who were stratified by menstrual cycle disturbance were randomized into four groups. The outcome variable was the change in spinal bone density measured by dual energy techniques. SETTING: A large metropolitan area. PARTICIPANTS: Sixty-one healthy, normal-weight physically active premenopausal women aged 21 to 45 years who experienced amenorrhea, oligomenorrhea, anovulation, or short luteal phase cycles completed the study. INTERVENTION: Therapies were cyclic medroxyprogesterone (10 mg/day for 10 days per month) and calcium carbonate (1,000 mg/day of calcium) in four groups: (A) (n = 16) cyclic medroxyprogesterone plus calcium carbonate; (B) (n = 16) cyclic medroxyprogesterone with calcium placebo; (C) (n = 15) placebo medroxyprogesterone with active calcium; or (D) (n = 14) both medroxyprogesterone and calcium placebos. RESULTS: The initial bone density (mean = 1.12 g/cm2) did not differ by group (P = 0.85). The 1-year bone density change was strongly related to treatment with medroxyprogesterone (P = 0.0001) and weakly to calcium (P = 0.072) treatment. Bone density increased significantly (+1.7% +/- 0.5%, +/- SEM, P = 0.004) in the medroxyprogesterone-treated groups (A and B), did not change in the calcium-treated group (C) (-0.7% +/- 0.6%, P = 0.28), and decreased on both placebos (D) (-2.0% +/- 0.6%, P = 0.005). CONCLUSIONS: Cyclic medroxyprogesterone increased spinal bone density in physically active women experiencing amenorrhea or ovulatory disturbances. POTENTIAL CLINICAL SIGNIFICANCE: Amenorrhea, oligomenorrhea, anovulation, and short luteal phase cycles are common in premenopausal women and associated with spinal bone loss occurring at a stage of life when bone density would normally be stable or increasing. This controlled trial shows a significant gain in bone in women in the cyclic medroxyprogesterone intervention group, whereas those subjects in the placebo group lost bone. Calcium supplementation appeared to be helpful but did not reach statistical significance. The implications of these findings for the prevention of osteoporosis warrant further investigation.
With the support of the Swedish National Institute of Health a national information service was started in 1993 aiming to capture the abuse of doping agents in the general public. It was organized as a telephone service, called the Anti-Doping Hot-Line, from our department and managed by trained nurses co-operating with clinical pharmacologists. Important information collected about all callers (anonymous) was: date of call, its origin, category of caller, doping experience and main question being asked. Abusers were asked about their age, sex, affiliation, abused drug(s), duration of abuse, habit of administration and adverse reactions (ADRs). Between October 1993 and December 2000 25,835 calls were received with a peak during spring and autumn. Most calls (12,400) came from non-abusers, 60% being males. Callers connected with gyms represented the largest group (30%). Most calls about specific drugs concerned anabolic androgenic steroids (AAS). Other drugs or products included ephedrine, clenbuterol and creatine. The most commonly abused anabolic steroids were testosterone, nandrolone-decanoate, methandienone and stanozolol. The ten most commonly reported ADRs of AAS were aggressiveness (835), depression (829), acne (770), gynecomastia (637), anxiousness (637), potency problems (413), testicular atrophy (404), sleep disorders (328), fluid retention (318) and mood disturbances (302). Female side effects included menstruation disturbances, hair growth in the face, lower voice and enlarged clitoris. During the period 1996-200, totally 4339 persons reported about 10,800 side effects. This figure should be compared with the very low number of ADRs (27) reported by prescribers to the Swedish ADR committee during the same period. Abuse of doping agents appears to be a new public health problem that needs detection, medical care and prevention.
A 46 year old women with long lasting menstruation disturbances and amenorrhea developed a chronic granulocytic leukemia and bilateral mammary tumors after pregnancy. The histologic examination revealed a myelosarcoma of the breast. The diagnostic features and the pathogenesis of these tumors are discussed. The severe hormonal disturbances could be accepted as localizing factors.
BACKGROUND & OBJECTIVE: Nasopharyngeal carcinoma (NPC) in children is a particular type of NPC with poor prognosis. This study was to analyze long-term treatment efficacy, and relevant factors influencing prognosis of NPC in children. METHODS: From Jan. 1975 to Dec. 1995, 47 children,7-14 years old, with NPC diagnosed by pathology received radiotherapy in our hospital. Radiation doses were 52-74 Gy/6-13 weeks [(64.68+/-5.68) Gy] in nasopharynx, and 46-73 Gy/5-13 weeks [(57.77+/-5.86) Gy] in neck; 21 received 1-3 cycles of chemotherapy (cisplatin, bleomycin, 5-fluoroucil, vincristine, and cyclophosphamide) before radiotherapy. Survival rate was calculated by Kaplan-Meier method, and analyzed by log-rank test with SPSS 10.0 software. RESULTS: The 1, 3, 5-year survival rates of 47 patients were 72.3%, 53.2%, and 40.4%, respectively. Clinical stage (P=0.046), mode of biopsy (P=0.024), radiation dose in nasopharynx (P=0.049), and short-term efficacy (P=0.005) correlated with prognosis of these patients. The average height of 15 male children with NPC who survived for more than 5 years was (161.5+/-1.23) cm. Among 3 female children with NPC who survived for more than 5 years, 2 had menstruation disturbance. CONCLUSIONS: Clinical stage, mode of biopsy, radiation dose in nasopharynx, short-term efficacy may influence prognosis of NPC in children. Radiation-induced long-term sequelae of NPC in children should not be overlooked.
Menstrual disorders are among the most frequent somatic complications and symptoms of eating disorders. Since 1972 amenorrhea has been registered among the diagnostic criteria of anorexia nervosa (AN). Although such a criterion is not essential for establishing a case of bulimia nervosa (BN), international research has, on several occasions, described menstruational disorders (in 95% of the cases) and amenorrhea (in 20% of the cases). This study was designed to assess the prevalence of eating disorders connected to menstruational disturbances having no organic causes. Our method was the following: the test was carried out via questionnaires (ANIS, BCDS, BITE, EDI, BDI) completed by patients of endocrine surgery of two gynecological out-patient wards. We have found the following (n = 75) prevalence figures: AN: 4%, BN: 12% while the total prevalence of clinical and subclinical eating disorder syndromes was at 44%. Our findings, are in line with other international findings.
Prolactin and thyrotropin response to TRH and basal gonadotropins levels in blood were investigated in insulin-treated adolescent females with regular menstruation cycles (Group I) and menstruation disturbances (Group II) compared with control, healthy girls. No significant differences were found in TSH secretion after TRH administration and basal LH, FSH levels between the observed groups. Blood basal PRL levels were significantly lower in young females in Group II, and a highly increased mobilization of PRL secretion (delta % PRL)--masked hyperprolactinaemia--in all of the groups of diabetic girls was revealed. Cytological examination of vaginal smears confirmed hypoestrogenic status of girls from Group II compared with Group I and the control group.
In 173 women with oligomenorrhea or amenorrhea, serum level of prolactin (PRL) was determined by radioimmunoassay method. In 22 cases (12.7%) the concentration of PRL was above 15 ng/ml. From the above women in 9 cases (5.2%) of all examined patients pituitary microadenoma was diagnosed. In 1 patient with pituitary microadenoma, coexisting partially empty sella was diagnosed. The mean basal PRL concentration in women with menstruation disturbances without hyperprolactinemia (group I) was found to be 7.1 +/- 3.1 ng/ml while the women with hyperprolactinemia without pituitary microadenoma (group II) was 32.9 +/- 5.8 ng/ml. In women with diagnosed pituitary microadenoma (group III) PRL concentration was 131.8 +/- 47.7 ng/ml. The group II and III demonstrated statistically significant increase of serum prolactin level in comparison to group I. Moreover in comparison with group I, statistically significant reduction of serum level of FSH, LH and estradiol 17 beta was confirmed in group with pituitary microadenoma. In group II significant decrease of serum concentration of LH and estradiol 17 beta was stated as well as lack of significant difference in serum level of FSH, in comparison to group I.
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Disturbances in bone marrow vascularisation can be one of the causes of diabetic osteopathy. The aim of the study was to answers the question if microalbuminuria as a results of capillary injury can be a sign of bone mineralisation disorders in IDDM renal sufficient patients. We examined 60 IDDM patients (30 women without menstruation disturbances; 30 men; age 25-36 years old). All the observed subjects were divided into groups: I-30 normoalbuminuric patients (0-29 mg/24 h); II-30 microabuminuric patients (30-295 mg/24 h). Bone mineral density (BMD) of femoral neck, lumbar spine (L2-L4) and total body was measured by dual energy X-ray absorptiometry (DEXA, Lunar). The biochemical parameters of bone turnover were measured both in serum and urine as follows: osteocalcine, total hydroxyproline (HPR, HPR/Cr), total alkaline phosphatase (AP) with bone fraction, total calcium (Ca, Ca/Cr) and inorganic phosphor (P). Microalbuminuric patients presented more severe bone turnover disturbances, shown by differences in: BMD and Z-score for femoral neck (p < 0.05), serum HPR (p < 0.05), AP (p < 0.05), AP (p < 0.01) and its bone fraction (p < 0.05). We proved the presence of statistically significant correlation coefficients for albuminuria and some densytometric and biochemical bone parameeters. Our results suggest that microalbuminuria can indirectly indicate the dynamic of bone turnover derangement in IDDM course. They are present mostly in the femoral neck, which because of the vascularisation type is particularly susceptible to subalimentation in the diabetic microangiopathy course.
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