Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0409974 (lupus)
 22,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Adolescents constitute a particular group of patients because of their young age and incomplete or erroneous knowledge of contraception and reproduction. The physical condition of a young girl and the medical history of her close relatives must be assessed in the contraception consultation. In the absence of obvious contraindications such as hypertension, diabetes, hypercholesterolemia or renal insufficiency, oral contraceptives (OCs) are most often indicated, whether or not the menstrual cycle is well established. It has been demonstrated that the hypothalamus resumes its previous activity when OC use is discontinued. Standard-dosed combined OCs are usually recommended, because low-dose formulations do not always sufficiently block the hypothalamus and may induce a state of relative hyperestrogenism. Girls with benign breast disease or whose mothers have histories of breast cancer may benefit from the antigonadotropic properties of a 19-nortestosterone derivative progestin administered from the 8th to the 25th cycle days. Some 19-nortestosterone derivatives can cause seborrhea, acne, or hair loss. Sequential OCs may be indicated at this age for temporary use in exceptional cases. Low-dose progestins are not completely effective and cause worrisome menstrual problems. In cases of renal insufficiency, lupus, or hypertension, derivatives of 17-OH progesterone can be used. Cyproterone acetate is indicated for adolescents with hirsutism. Barrier methods are not used by adolescents as often as the less reliable but simpler ovules or jellies. The diaphragm with jelly or the condom correctly used are the most reliable, but they have a bad reputation. Information campaigns have successfully promoted use in some countries. IUDs are strongly contraindicated for all young girls because of increased risks of infection and sexually transmitted diseases. In extreme necessity they may be used for mentally ill adolescents unable to use any other method.
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PMID:[Contraceptive methods for adolescents]. 385 20

Although the etiology of lupus is imperfectly understood, immune factors, heredity, viral infections, and hormonal status are known to play a role. Studies of the sex ratio of lupus patients indicate that before age 10, twice as many girls as boys are affected, but after 12 years, 9.6 females are affected for each male. The incidence of lupus is almost constant for males of all ages but is much higher for women of fertile age than for other women. The deleterious effect of synthetic estrogens was 1st reported in 1966, and various studies since then have confirmed the results. The etiologic role of pregnancy is debated, but pregnancies can be successfully carried to term in periods of remission. Certain lines of mice spontaneously develop an autoimmune disease resembling disseminated lupus erythematosus. Anti-DNA antibodies appear earlier in the female and death from renal insufficiency occurs earlier than in males. Prepubertal castration does not influence the survival of female mice but significantly reduces that of males. Treatment with estradiol diminishes survival of castrated males and females, while treatment with androgens increases survival time of castrated to control females and of castrated males to that of control males. The timing and dose of treatment modify the response. Progesterone administered alone does not influence survival time of females but somewhat increases that of castrated males. Cyproterone acetate, an antiandrogenous progestin, has no effect in 2-3 week old males. Danazol, a moderately active androgen, has no effect on female mice. Nafoxidine, an antiestrogen, increases survival times. These results support the opinion that estrogens aggravate lupus while androgens have a protective effect. Different hormonal treatments have been prescribed for human lupus. Some beneficial effect for female patients has been observed with danazol, but the drug entails significant hepatic, metabolic, and hypertensive risks and may produce androgenic side effects such as voice modifications and hirsutism. Cyproterone acetate, a derivative of 17-hydroxyprogesterone, is without vascular and metabolic side effects and can halt ovarian function at a dose of 50 mg/day. It behaves as a peripheral antiandrogen and may have androgen agonist activity in some tissues. The mechanism of interaction of sex hormones in lupus may be explained by their influence on cellular and humoral immunity. Estrogens appear to suppress cellular immunity and stimulate humoral immunity, while androgens appear to play a suppressive role at the 2 levels. Contraception for women with lupus must be effective. Combined oral contraceptives and low-dose norsteroid progestins are contraindicated because of their thromboembolic and vascular risks. Low-dose progestins may be used but cause hyperestrogenism in some women. Chlormadinone acetate at a daily dose of 10 mg has no significant vascular effect. IUDs may have reduced efficacy during corticotherapy and pose a risk of infection. Only mechanical vaginal methods ose no threats for lupus patients, but they must be understood and accepted by the patient.
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PMID:[Hormones and lupus]. 391 21