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Shinan Luong - One of the best experts on this subject based on the ideXlab platform.
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a systematic review and meta analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone agonists gnrha in women of child bearing age with autoimmune rheumatic disease
Expert Review of Clinical Immunology, 2020Co-Authors: Shinan Luong, Anthony Isaacs, Zhixin Liu, Fang E Sin, Ian GilesAbstract:Objectives: To systematically review risk of sustained amenorrhea with intravenous (IV) cyclophosphamide in autoimmune rheumatic disease (ARD), and evaluate efficacy of gonadotropin-releasing hormone agonists (GnRHa) to reduce this risk.Methods: Systematic search for papers reporting incidence of sustained amenorrhea ≥12 months in ARD following: IV cyclophosphamide; or GnRHa and IV cyclophosphamide compared to IV cyclophosphamide alone.Results: From 31 articles and 1388 patients (mean age 27.7 years) sustained amenorrhea occurred in 273 patients (19.7%). Of 56 patients (mean age range 23.9-25.6 years) receiving GnRHa and IV cyclophosphamide, and 37 controls (mean age range 25-30.1 years) given IV cyclophosphamide only, sustained amenorrhea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) controls. Pooled odds ratio of sustained amenorrhea with GnRHa and cyclophosphamide versus cyclophosphamide alone was 0.054 (95% CI 0.0115-0.2576 p 5 g. GnRHa reduced this risk and should be considered with IV cyclophosphamide in women of childbearing age with ARD.
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op0044 a systematic review and meta analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone analogues in women of child bearing age with autoimmune rheumatic disease
Annals of the Rheumatic Diseases, 2019Co-Authors: Shinan Luong, Anthony Isaacs, Fang E Sin, Ian GilesAbstract:Background Premature ovarian insufficiency (POI) is a side effect of intravenous cyclophosphamide (i.v.CYC), which is the treatment of choice for many severe manifestations of autoimmune rheumatic disease (ARD) (1). The risk of POI post-CYC appears to be dependent on cumulative dose and patient age but has not been precisely quantified. Gonadotropin Releasing Hormone Analogues (GnRHa) may reduce this risk (2). Studies however, on GnRHa and CYC use in ARD patients have been limited in size and/or by combined analysis with patients receiving CYC for malignancies. Objectives In order to more precisely categorise the risk of POI in ARD patients, and determine whether GnRHa are effective in reducing this risk, we performed a systematic review to assess the risk of sustained Amenorrhoea with i.v.CYC in ARD and a meta-analysis of the efficacy of GnRHa in reducing this risk. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, we searched English language papers using Pubmed, MEDLINE, EMBASE and the Cochrane Library to April 2018. We included all studies that reported the incidence of sustained Amenorrhoea (defined as at least 12 months of Amenorrhoea) during i.v.CYC treatment in patients with ARD; and those that assessed sustained Amenorrhoea in patients receiving GnRHa and i.v.CYC, compared to controls receiving i.v.CYC alone. Results 1099 articles were identified and their titles and abstracts screened, following which 81 papers were selected for full text review. 31 studies were then identified that addressed the risk of sustained Amenorrhoea with i.v.CYC in n=1382 patients with ARD. The majority of these patients had systemic lupus erythematosus (1326 out of 1382 patients, 96.0%). The mean age was 24.9 (range 13-36.1) years. Sustained Amenorrhoea occurred in 269 patients (19.5%, range 0-54% depending on age and cumulative cyclophosphamide dose). The rate of sustained Amenorrhoea significantly positively correlated with increasing cumulative cyclophosphamide dose, and occurred in patients with a mean age ranging from 13-36.1 years at mean cumulative doses ranging from 1-20.1g. A further 3 studies assessed ARD patients given i.v.CYC +/- GnRHa, including 56 patients (mean age range 23.9-25.6 years) receiving GnRHa and i.v.CYC, and 37 controls (mean age range 25-29.4 years) given i.v.CYC only. Sustained Amenorrhoea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) of controls. The pooled odds ratio of sustained Amenorrhoea with GnRHa and i.v.CYC compared to i.v.CYC alone was 0.0543 (95%CI 0.0115-0.2576, p=0.0002). The number needed to treat was 2.7 (95%CI 2.0-4.4) and the absolute risk reduction was 37.0% (95%CI 35.6-38.4%). Conclusion Although the risk of POI with i.v.CYC was associated with increasing age, it was observed across all age groups and from cumulative doses of 1g or more. GnRHa markedly reduced this risk in ARD, and therefore should be considered for concomitant use with i.v.CYC in all women of child-bearing age with ARD. References [1] Marder W, Fisseha S, Ganser MA, Somers EC. Ovarian damage during chemotherapy in autoimmune diseases broad health implications beyond fertility. Clin Med Insights Reprod Health 2012;6:9-18. [2] Marder W, McCune WJ, Wang L, Wing JJ, Fisseha S, McConnell DS, et al. Adjunctive GnRH-a treatment attenuates depletion of ovarian reserve associated with cyclophosphamide therapy in premenopausal SLE patients. Gynecol Endocrinol2012;28(8):624-7. Acknowledgement Arthritis Australia Disclosure of Interests Shi-Nan Luong: None declared, Anthony Isaacs: None declared, Fang En Sin : None declared, Ian Giles Consultant for: UCB, Speakers bureau: UCB
Ian Giles - One of the best experts on this subject based on the ideXlab platform.
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a systematic review and meta analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone agonists gnrha in women of child bearing age with autoimmune rheumatic disease
Expert Review of Clinical Immunology, 2020Co-Authors: Shinan Luong, Anthony Isaacs, Zhixin Liu, Fang E Sin, Ian GilesAbstract:Objectives: To systematically review risk of sustained amenorrhea with intravenous (IV) cyclophosphamide in autoimmune rheumatic disease (ARD), and evaluate efficacy of gonadotropin-releasing hormone agonists (GnRHa) to reduce this risk.Methods: Systematic search for papers reporting incidence of sustained amenorrhea ≥12 months in ARD following: IV cyclophosphamide; or GnRHa and IV cyclophosphamide compared to IV cyclophosphamide alone.Results: From 31 articles and 1388 patients (mean age 27.7 years) sustained amenorrhea occurred in 273 patients (19.7%). Of 56 patients (mean age range 23.9-25.6 years) receiving GnRHa and IV cyclophosphamide, and 37 controls (mean age range 25-30.1 years) given IV cyclophosphamide only, sustained amenorrhea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) controls. Pooled odds ratio of sustained amenorrhea with GnRHa and cyclophosphamide versus cyclophosphamide alone was 0.054 (95% CI 0.0115-0.2576 p 5 g. GnRHa reduced this risk and should be considered with IV cyclophosphamide in women of childbearing age with ARD.
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op0044 a systematic review and meta analysis of the gonadotoxic effects of cyclophosphamide and benefits of gonadotropin releasing hormone analogues in women of child bearing age with autoimmune rheumatic disease
Annals of the Rheumatic Diseases, 2019Co-Authors: Shinan Luong, Anthony Isaacs, Fang E Sin, Ian GilesAbstract:Background Premature ovarian insufficiency (POI) is a side effect of intravenous cyclophosphamide (i.v.CYC), which is the treatment of choice for many severe manifestations of autoimmune rheumatic disease (ARD) (1). The risk of POI post-CYC appears to be dependent on cumulative dose and patient age but has not been precisely quantified. Gonadotropin Releasing Hormone Analogues (GnRHa) may reduce this risk (2). Studies however, on GnRHa and CYC use in ARD patients have been limited in size and/or by combined analysis with patients receiving CYC for malignancies. Objectives In order to more precisely categorise the risk of POI in ARD patients, and determine whether GnRHa are effective in reducing this risk, we performed a systematic review to assess the risk of sustained Amenorrhoea with i.v.CYC in ARD and a meta-analysis of the efficacy of GnRHa in reducing this risk. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, we searched English language papers using Pubmed, MEDLINE, EMBASE and the Cochrane Library to April 2018. We included all studies that reported the incidence of sustained Amenorrhoea (defined as at least 12 months of Amenorrhoea) during i.v.CYC treatment in patients with ARD; and those that assessed sustained Amenorrhoea in patients receiving GnRHa and i.v.CYC, compared to controls receiving i.v.CYC alone. Results 1099 articles were identified and their titles and abstracts screened, following which 81 papers were selected for full text review. 31 studies were then identified that addressed the risk of sustained Amenorrhoea with i.v.CYC in n=1382 patients with ARD. The majority of these patients had systemic lupus erythematosus (1326 out of 1382 patients, 96.0%). The mean age was 24.9 (range 13-36.1) years. Sustained Amenorrhoea occurred in 269 patients (19.5%, range 0-54% depending on age and cumulative cyclophosphamide dose). The rate of sustained Amenorrhoea significantly positively correlated with increasing cumulative cyclophosphamide dose, and occurred in patients with a mean age ranging from 13-36.1 years at mean cumulative doses ranging from 1-20.1g. A further 3 studies assessed ARD patients given i.v.CYC +/- GnRHa, including 56 patients (mean age range 23.9-25.6 years) receiving GnRHa and i.v.CYC, and 37 controls (mean age range 25-29.4 years) given i.v.CYC only. Sustained Amenorrhoea occurred in 2/56 (3.6%) patients treated with GnRHa, compared to 15/37 (40.5%) of controls. The pooled odds ratio of sustained Amenorrhoea with GnRHa and i.v.CYC compared to i.v.CYC alone was 0.0543 (95%CI 0.0115-0.2576, p=0.0002). The number needed to treat was 2.7 (95%CI 2.0-4.4) and the absolute risk reduction was 37.0% (95%CI 35.6-38.4%). Conclusion Although the risk of POI with i.v.CYC was associated with increasing age, it was observed across all age groups and from cumulative doses of 1g or more. GnRHa markedly reduced this risk in ARD, and therefore should be considered for concomitant use with i.v.CYC in all women of child-bearing age with ARD. References [1] Marder W, Fisseha S, Ganser MA, Somers EC. Ovarian damage during chemotherapy in autoimmune diseases broad health implications beyond fertility. Clin Med Insights Reprod Health 2012;6:9-18. [2] Marder W, McCune WJ, Wang L, Wing JJ, Fisseha S, McConnell DS, et al. Adjunctive GnRH-a treatment attenuates depletion of ovarian reserve associated with cyclophosphamide therapy in premenopausal SLE patients. Gynecol Endocrinol2012;28(8):624-7. Acknowledgement Arthritis Australia Disclosure of Interests Shi-Nan Luong: None declared, Anthony Isaacs: None declared, Fang En Sin : None declared, Ian Giles Consultant for: UCB, Speakers bureau: UCB
Utami Listyan - One of the best experts on this subject based on the ideXlab platform.
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Hubungan Pemakaian Kontrasepsi Suntik dengan Kejadian Amenorea di Wilayah Kerja Puskesmas Atari Jaya Kecamatan Lalembuu Kabupaten Konawe Selatan Tahun 2015
'Poltekkes Kemenkes Kendari', 2018Co-Authors: Wahida Wahida, Utami ListyanAbstract:Amenorrhoea is no occurrence of menstruation for 3 months or more in women who have experienced menstrual cycles. Some cases of amenorrhea can be found in injectable contraceptive acceptors. This is confirmed by the data from Southeast Sulawesi province that there are 284,784 and 201,627 (70.8%) among them experiencing amenorrhea. Objective: To find out whether there is a relationship between injectable contraception and the incidence of amenorrhea in the work area of Atari Jaya Health Center, Lalembuu District, South Konawe Regency in 2015. Research methods: Analytical research with design cross-study. The sample in this study amounted to 92 injectable contraceptive acceptors. This research uses an accidental sampling technique. Data analysis included univariate and bivariate analysis using the SPSS (Chi-Square test) program at the level of confidence = 0.05. Amenorrhoea is a complaint that is often felt in injectable contraceptive acceptors. Of the 92 injectable contraceptive acceptors who suffered secondary Amenorrhoea, there were 59 (64.1%) acceptors while 33 (35.9%) acceptors did not suffer from secondary Amenorrhoea. There is the relationship of injectable contraception with the incidence of amenorrhea. Conclusion: There is a correlation between injectable contraceptive use and the incidence of amenorrhea in the work area of Atari Jaya Community Health Center, Lalembuu Subdistrict, South Konawe Regency in 2015.Amenore adalah terjadinya haid selama 3 bulan atau lebih pada wanita yang sudah mengalami siklus haid. Beberapa kasus amenore dapat ditemukan pada akseptor kontrasepsi suntik. Hal ini diperkuat dengan data dari Provinsi Sulawesi Tenggara terdapat 284.784 dan 201.627 (70,8%) diantaranya mengalami amenore. Tujuan: Mengetahui apakah ada hubungan antara kontrasepsi suntik dengan kejadian amenore di wilayah kerja Puskesmas Atari Jaya Kecamatan Lalembuu Kabupaten Konawe Selatan Tahun 2015. Metode penelitian: Penelitian analitik dengan desain studi silang. Sampel dalam penelitian ini berjumlah 92 akseptor kontrasepsi suntik. Penelitian ini menggunakan teknik accidental sampling. Analisis data meliputi analisis univariat dan bivariat menggunakan program SPSS (uji Chi-Square) pada taraf kepercayaan = 0,05. Amenore merupakan keluhan yang sering dirasakan pada akseptor kontrasepsi suntik. Dari 92 akseptor kontrasepsi suntik yang mengalami amenore sekunder terdapat 59 (64,1%) akseptor sedangkan 33 (35,9%) akseptor tidak menderita amenore sekunder. Ada hubungan kontrasepsi suntik dengan kejadian amenore. Kesimpulan: Ada hubungan antara penggunaan kontrasepsi suntik dengan kejadian amenore di wilayah kerja Puskesmas Atari Jaya Kecamatan Lalembuu Kabupaten Konawe Selatan Tahun 2015
A Hassanzadeh Rad - One of the best experts on this subject based on the ideXlab platform.
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PO-0093 Familial Pure Gonadal Dysgenesis
Archives of Disease in Childhood, 2014Co-Authors: Setilla Dalili, Shahin Kohmanaee, A Hassanzadeh RadAbstract:Introduction Gonadal dysgenesis in females which would be presented with 46 XX is characterised by the presence of primary amenorrhea with or without normal secondary sexual characteristics. It is commonly described without normal secondary sexual characteristics such as breast development. In this study, we aimed to report a familial pure gonadal dysgenesis with and without normal secondary sexual characteristics. Case presentations In a family consisting 9 siblings of non-consanguineous parents, three sisters (age 22, 17 and 13 years) presented with complaints of Amenorrhoea. The 13 years old girl mentioned no secondary characteristics of puberty. The 17 years old girl showed secondary characteristics of puberty without previous history of hormone therapy. Also, the 22 years old girl showed secondary characteristics and clinicians recommended hormone therapy after marriage for her infertility and even delivered a baby. The elder two sisters had a normal female phenotype and the youngest had amenorrhea with no breast development (B1) and pubic hair. Furthermore, according to physical examination, deafness was not mentioned. Conclusions According to results, it seems that clinicians should consider different presentation for pure gonadal dysgenesis with familial pattern and further evaluation is needed in malignant degeneration of the gonadal dysgenesis in the patients with 46, XX PGD.
Roger A Lobo - One of the best experts on this subject based on the ideXlab platform.
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increased anti mullerian hormone levels and ovarian size in a subgroup of women with functional hypothalamic amenorrhea further identification of the link between polycystic ovary syndrome and functional hypothalamic amenorrhea
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Enrico Carmina, Franca Fruzzetti, Roger A LoboAbstract:Background Functional hypothalamic amenorrhea is a disorder characterized by cessation of menstrual cycles in the absence of organic disease. In most patients, it occurs in adult life after a stressful event and may be related to a condition of mild chronic energy deprivation. The endocrine pattern is characterized by low estrogen levels with an absent response to a progestogen challenge test and low-normal gonadotropin levels. A few studies have shown that some of these women may have some features of polycystic ovary syndrome; these features include an increased androgen response to gonadotropins, increased anti-Mullerian hormone levels, and altered ovarian morphology or increased ovarian size. These findings suggest a link between these 2 completely different disorders: functional hypothalamic amenorrhea and polycystic ovary syndrome. The importance of the possible coexistence of these disorders in some women is important for follow-up of these women and in their treatment if they desire to become pregnant. Objective To determine whether a subgroup of well-characterized women with functional hypothalamic amenorrhea may have the coexistence of polycystic ovary syndrome. Study Design Retrospective analysis of women with functional hypothalamic amenorrhea. Forty consecutive patients and 28 normal age-matched control patients were studied. Blood was obtained for serum anti-Mullerian hormone, androgens, and other hormone levels and all women had ovarian ultrasonographic measurements. Results In the entire group of women with functional hypothalamic amenorrhea, anti-Mullerian hormone and ovarian volume were greater than in control patients. In 13 patients (32.5%), anti-Mullerian hormone was elevated (>4.7 ng/mL, levels consistent with polycystic ovary syndrome) and in this group, ovarian volume was significantly greater than in the remaining patients with functional hypothalamic amenorrhea. Four of the 13 women with functional hypothalamic amenorrhea who had elevated anti-Mullerian hormone levels (10%), also had ovarian volume ≥10 cc (consistent with polycystic ovarian syndrome). In these patients all studied androgens were in the upper normal range or slightly elevated despite low-normal gonadotropins; mean total testosterone was significantly greater than in the other patients with increased anti-Mullerian hormone values with normal ovarian size ( P Conclusions As many as 10% of women with functional hypothalamic amenorrhea may have the coexistence of polycystic ovary syndrome. Because no signs or symptoms of this disorder were reported by these women before the appearance of the amenorrhea, it does not seem to be a coincidental relationship. The possibility that functional hypothalamic amenorrhea favors the appearance of polycystic ovary syndrome or more likely, that a mild (ovulatory) phenotype of polycystic ovary syndrome predisposes to the development of functional hypothalamic amenorrhea should be considered. Possible mechanisms are unclear and need to be investigated but may involve common vulnerabilities such as psychologic and mood disturbances.