Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0600142 (hot flushes)
 1,242 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The introduction of steroid 'add-back' regimens draws on the recognition that several clinical entities targeted for treatment with gonadotrophin-releasing hormone agonist (GnRHa) are not '6-month diseases'. Included under this heading are individuals suffering from symptomatic endometriosis (not desires of pregnancy), uterine fibroids (ineligible or disinterested in definitive surgical therapy), ovarian hyperandrogenism, premenstrual syndrome, menopausal transition, or dysfunctional uterine bleeding. A 6-month course of therapy with a GnRHa does not adversely affect lipoprotein economy and therefore presumably the corresponding cardiovascular risk. A 6-month course of GnRHa therapy appears to be associated with a substantial decrease (of up to 8.2%) in lumbar bone density, a phenomenon which may not be entirely reversible 6 months after discontinuation of therapy. In principle, steroid 'add-back' therapy should diminish some or all of the side-effects associated with GnRHa therapy, may provide a medical treatment option for patients representing a high surgical risk, and may delay surgical intervention if desired. On the other hand, a steroid 'add-back' therapy may delay tissue diagnosis, be associated with a substantial cost as well as with the need for parenteral route of administration. Norethindrone-only (but not medroxyprogesterone acetate-only) 'add-back' regimens have proved promising in the context of endometriosis. Non-concurrent oestrogen/progestin 'add-back' regimens proved promising in the context of uterine fibroids. Substantial additional studies would have to be carried out to validate the utility of steroid 'add-back' regimens. Special emphasis will have to be placed on the evaluation of long-term utility with an eye towards assessing clinical efficacy, impact on lipoprotein economy, impact on bone density, impact on urogenital tissues, and impact on the hot flush. The concurrent or non-concurrent use of non-steroid 'add-back' regimens will also most likely constitute a major component of future studies.
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PMID:Long-term gonadotrophin-releasing hormone agonist therapy: the evolving issue of steroidal 'add-back' paradigms. 796 53

The introduction of steroid "add-back" regimen draws on the recognition that several clinical entities targeted for treatment with GnRHa are not "six-month diseases". Included under this heading are individuals suffering from symptomatic endometriosis (not desirous of pregnancy), uterine fibroids (ineligible or disinterested in definitive surgical therapy), ovarian hyperandrogenism, premenstrual syndrome, menopausal transition, or dysfunctional uterine bleeding. A six month course of therapy with a GnRHa does not adversely affect lipoprotein economy and therefore presumably the corresponding cardiovascular risk. A six month course of GnRHa therapy appears to be associated with a substantial decrease (of up to 8.2%) in lumbar bone density, a phenomenon which may not be entirely reversible six months after discontinuation of therapy. In principle, steroid "add-back" therapy should diminish some or all of the side effects associated with GnRHa therapy, may provide a medical treatment option for patients representing a high surgical risk, and may delay surgical intervention if desired. On the other hand, a steroid "add-back" therapy may delay tissue diagnosis, be associated with a substantial cost as well as with the need in parenteral route of administration. Norethindrone-only (but not medroxyprogesterone acetate-only) "add-back" regimens have proved promising in the context of endometriosis. Non-concurrent estrogen/progestin "add-back" regimens proved promising in the context of uterine fibroids. Substantial additional studies would have to be carried out to validate the utility of steroid "add-back" regimens. Special emphasis will have to be placed on the evaluation of long-term utility with an eye towards assessing clinical efficacy, impact on lipoprotein economy, impact on bone density, impact on urogenital tissues, and impact on the hot flash. The concurrent or non-concurrent use of non-steroid "add-back" regimen will also most likely constitute a major component of future studies.
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PMID:Long-term gonadotropin-releasing hormone agonist therapy: the evolving issue of steroidal "add-back" paradigms. 858 24

There are a few reports of side-effects of LHRHa treatment in childhood, the mechanisms of which remain little understood. Such effects can be local reactions: erythema, induration, wheal and sterile abscess formation, which can be possible causes of therapy failure. There are negative effects on growth velocity and final height requiring rhGH therapy or a suppressive treatment when bone age >13 years. Excessive weight gain can occur by various mechanisms: menopausal-like phenomena, or LHRHa influence on hypothalamic and/or leptin-mediated control of body weight. Other possible adverse effects involve increased ovarian volume with possible POS development; however, there is no evidence correlating LHRHa, hyperandrogenism and POS. The latter appears related to CPP onset with pre-existing hyperandrogenism, although lengthier follow-up is necessary to confirm this. Bone density decreases during therapy, but final peak bone mass is in the normal range. Frequent transitory side-effects include headaches, hot flushes, depression and irregular menses.
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PMID:Side effects of GnRH analogue treatment in childhood. 1096 24