Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Breast cancer is among the commonest malignant diseases in women. Over the past two decades tamoxifen has been generally accepted as an endocrine therapy of choice for prevention of breast cancer recurrence. Although tamoxifen was thought to have only a few adverse effects, several reports indicate that it is associated with an increase incidence of proliferative and neoplastic changes in the endometrium, with a 1.3 to 7.5 relative risk of developing endometrial carcinoma. The increased risk of endometrial cancer following the use of tamoxifen has stimulated studies on endometrial diagnostic screening methods. During the past ten years several reports have shown the benefits of transvaginal ultrasonography in detecting endometrial pathologies in patients receiving tamoxifen. Sonohysterography has been claimed to be a useful diagnostic tool on differentiating space-occupying lesion, eg. endometrial polyp, from abnormal endometrial-myometrial junction while the contribution of pulsed flow velocity in diagnosis of endometrial pathologies seems to be inconclusive. More recently a few factors have been identified as risk of developing endometrial cancer after tamoxifen use. These include pre-existing endometrial pathologies, obesity, and prior ERT use. This information provides us a more sensible way in following breast cancer patients receiving tamoxifen. It is proposed here that postmenopausal breast cancer patients intend to have tamoxifen treatment should receive a "two - step evaluation". The pretreatment evaluation is aimed to classify patients at risk of later development of endometrial pathologies after being exposed to tamoxifen while the ongoing evaluation is designed to closely follow the patents after the initiation of tamoxifen in hope that this will provide a tool for early diagnosis or hopefully a protective measure against endometrial carcinoma associated with tamoxifen therapy.
 ...
PMID:Prevention of Endometrial Cancer in Breast Cancer Patients Taking Tamoxifen : The Gynecologists' Role. 1271 83

A 13-year-old, obese, female cynomolgus monkey (Macaca fascicularis) was observed in a 5-year neurobehavioral study and was humanely euthanatized for experimental purposes. During this observational study, the monkey was noted to ovulate only rarely (0-3 times a year), with a prolonged menstrual cycle length (up to 161 days), hyperandrogenism (androstenedione area under the curve in response to adrenocorticotropic hormone up to 27.64 ng/ml), and hyperinsulinemia (fasting insulin up to 65.85 microIU/ml). This animal's body mass index was 65.46 kg/m(2), with central obesity. On postmortem examination, the uterus was moderately enlarged, with an eccentric lumen and a broad-based endometrial polyp that consisted of complex glandular hyperplasia with atypia. Both ovaries contained many 2- to 3-mm follicles, without any corpora lutea. A diagnosis of polycystic ovary syndrome was made based on the clinical history, endocrinology, and gross and histopathologic findings.
 ...
PMID:Polycystic ovary syndrome with endometrial hyperplasia in a cynomolgus monkey (Macaca fascicularis). 1858 99

In this study, we aimed to estimate the frequency of premalignant and malignant lesions in endometrial polyps, and to evaluate associated clinical and demographic factors. A literature search was performed in major databases and the gray literature using the terms polyps OR endometrial polyp AND endometrial neoplasms OR endometrial cancer OR endometrial hyperplasia OR malignan*. Studies describing the frequency of premalignant and malignant lesions in endometrial polyps and any clinical or demographic factors associated with malignant lesions extracted using hysteroscopy were considered eligible. Independent investigators selected the studies and extracted the data. A meta-analysis was performed using a random-effects model and meta-regression. We identified 37 studies (comprising 21,057 patients) of endometrial polyps. The prevalence of premalignant and malignant lesions was 3.4% (95% confidence interval [CI], 2.8-4.1; I2, 80.5%). Abnormal uterine bleeding (prevalence ratio [PR], 1.47; 95% CI, 1.27-1.69; I2, 82.4%), menopausal status (PR, 1.67; 95% CI, 1.48-1.89; I2, 78.4%), age >60 years (PR, 2.41; 95% CI, 1.84-3.16; I2, 81.5%), diabetes mellitus (PR, 1.76; 95% CI, 1.43-2.16; I2, 0.0%), systemic arterial hypertension (PR, 1.50; 95% CI, 1.20-1.88; I2, 75.9%), obesity (PR, 1.41; 95% CI:1.13-1.76; I2, 41.2%), and tamoxifen use (PR, 1.53; 95% CI, 1.06-2.21; I2, 0.0%) were associated with endometrial polyp malignancy. However, breast cancer (PR, 0.83; 95% CI, 0.44-1.57; I2, 0.0%), hormonal therapy (PR, 0.93; 95% CI, 0.67-1.30; I2, 31.7%), parity (PR, 0.87; 95% CI, 0.39-1.96; I2, 78.1%), and endometrial polyp size (PR, 1.05; 95% CI, 0.70-1.57; I2, 44.7%) were not associated with malignancy of endometrial polyps. Three of every 100 women with clinically recognized polyps, a condition associated with specific clinical and demographic factors, will harbor premalignant or malignant lesions.
 ...
PMID:Factors Associated with Malignancy in Hysteroscopically Resected Endometrial Polyps: A Systematic Review and Meta-Analysis. 2945 47

Endometrial polyps are a common finding, with a prevalence of about 40%, and are usually diagnosed incidentally as most are asymptomatic. Symptomatic polyps usually present with abnormal uterine bleeding and/or sub-fertility. About 25% of polyps resolve spontaneously if managed conservatively. The usual management of endometrial polyps, symptomatic or asymptomatic, is polypectomy, performed primarily to exclude malignancy within the polyp despite the overall risk of malignancy being low (about 3%). The main risk factors for malignancy are menopause and abnormal uterine bleeding, with hypertension, obesity, diabetes mellitus, and tamoxifen use thought to play a lesser role. Transvaginal ultrasonography is the primary diagnostic tool for endometrial polyps although visualization by hysteroscopy is the gold standard for diagnosis. There is no proven preventative or medical treatment, with complete polyp removal under hysteroscopic guidance the recommended surgical treatment. Some women may decline surgical endometrial polyp management due to the small inherent risks. Conservative management is an option for asymptomatic premenopausal and postmenopausal women, whilst polypectomy is recommended for all women with abnormal uterine bleeding. Management should be individualized and made in consultation with the patient.
 ...
PMID:To treat or not to treat? An evidence-based practice guide for the management of endometrial polyps. 3249 25