Estrogen Replacement in Women of Fertile Years with Hypopituitarism

Mah, Peak Mann; Webster, J; Jönsson, Pernilla; Feldt‐Rasmussen, Ulla; Kołtowska-Häggström, Maria; Ross, R. J. M.

doi:10.1210/jc.2005-1207

Cited by 55 publications

(46 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The data obtained from the KIMS database seem to support this hypothesis (123). The majority of women of fertile years with hypopituitarism within KIMS takes oral estrogen replacement therapy.…”

Section: Central Hypogonadismmentioning

confidence: 81%

“…The waist-to-hip ratio was greater in women taking oral estrogens, again suggesting that oral estrogens reduce the action of GH on fat mass. In addition, women using the oral contraceptive had lower serum IGF1 levels and required twice the GH dose compared with patients receiving transdermal estradiol (123). Estrogen replacement by the oral route, therefore, aggravates existing metabolic and body compositional abnormalities of the GH-deficient state and results in a relative resistance to GH replacement therapy, at least in terms of the effects on serum IGF1.…”

Section: Central Hypogonadismmentioning

confidence: 99%

See 1 more Smart Citation

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

View full text Add to dashboard Cite

Severe GH deficiency (GHD) in adults has been described as a clinical entity. However, some of the features associated with GHD could be due to unphysiological and inadequate replacement of other pituitary hormone deficiencies. This may be true for glucocorticoid replacement that lacks a biomarker making dose titration and monitoring difficult. Moreover, oral estrogen replacement therapy decreases IGF1 levels compared with the transdermal route, which attenuates the responsiveness to GH replacement therapy in women. In addition, in untreated female hypogonadism, oral estrogen may augment the features associated with GHD in adult women. Important interactions between the hormones used for replacing pituitary hormone deficiency occur. Introducing GH replacement may unmask both an incipient adrenal insufficiency and central hypothyroidism. Therefore, awareness and proper monitoring of these hormonal interactions are important in order to reach an optimal replacement therapy. This review will focus on the complex hormonal interactions between GH and other pituitary hormones in GHD and in GH replacement. European Journal of Endocrinology 161 S85-S95

show abstract

Section: Central Hypogonadismmentioning

confidence: 81%

Section: Central Hypogonadismmentioning

confidence: 99%

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Filipsson

Johannsson

2009

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the production of hepatic IGF1, which mediates the effect of GH on bone, is impaired by oral estrogens and enhanced by testosterone (30,31). However, this was counteracted by higher GH doses in CP women than in CP men, which resulted in similar serum IGF1 levels in patients and controls (30). Although the exact GH replacement during childhood and adolescence is not known for the cohort, patients of both genders were of a similar height and lean mass compared with controls, suggesting rather adequate previous GH therapy.…”

Section: Discussionmentioning

confidence: 99%

Hypothalamic involvement and insufficient sex steroid supplementation are associated with low bone mineral density in women with childhood onset craniopharyngioma

Holmer

Popović²,

Ekman³

et al. 2011

European Journal of Endocrinology

View full text Add to dashboard Cite

Context: Data on bone mineral density (BMD) are lacking in adults with childhood onset (CO)-craniopharyngioma (CP) with hypothalamic damage from the tumor. In patients with CO GH deficiency, BMD increases during GH treatment. Objective: The aims were to evaluate BMD in adults with CO-CPs on complete hormone replacement, including long-term GH and to evaluate the impact of hypothalamic damage on these measures. Design and participants: BMD (dual-energy X-ray absorptiometry), markers of bone turn over, physical activity and calcium intake were assessed in 39 CO-CP adults (20 women), with a median age of 28 (17-57) years, in comparison with matched population controls. Results: Late puberty induction was recorded in both genders, but reduced androgen levels in females only. Only CP women had lower BMD (PZ0.03) at L2-L4, and reduced Z-scores at femoral neck (PZ0.004) and L2-L4 (PZ0.004). Both genders had increased serum leptin levels (PZ0.001), which significantly correlated negatively with BMD at L2-L4 (PZ0.003; rZK0.5) and 45% of CP women had Z-score levels %K2.0 S.D. Furthermore, 75% of those with a Z-score %K2.0 S.D. had hypothalamic involvement by the tumor. Calcium intake (PZ0.008) and physical activity (PZ0.007) levels were reduced in CP men only. Levels of ostecalcin and crossLaps were increased in CP men only. Conclusions: Despite continuous GH therapy, low BMD was recorded in CO-CP females. Insufficient estrogen and androgen supplementation during adolescence was the main cause, but hypothalamic involvement with consequent leptin resistance was also strongly associated with low BMD in both genders.

show abstract

“…From the Pfizer KIMS database, among 315 women with hypopituitarism taking estrogens, 86% were prescribed oral formulations, with one-third using oral contraceptive steroids [72]. On average, those taking oral contraceptives required 55-70% more GH, and those taking oral formulations 20-30% more than those using transdermal patches [71,72].…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Sex steroids and the GH axis: Implications for the management of hypopituitarism

Birzniece

2017

Best Practice & Research Clinical Endocrinology & Metab

View full text Add to dashboard Cite

Growth hormone (GH) regulates somatic growth, substrate metabolism and body composition. Sex hormones exert profound effect on the secretion and action of GH.Estrogens stimulate the secretion of GH, but inhibit the action of GH on the liver, an effect that occurs when administered orally. Estrogens suppress GH receptor signaling by stimulating the expression proteins that inhibit cytokine receptor signaling. This effect of estrogens is avoided when physiological doses of estrogens are administered via a non-oral route. Estrogen-like compounds, such as selective estrogen receptor modulators, possess dual properties of inhibiting the secretion as well as the action of GH. In contrast, androgens stimulate GH secretion, driving IGF-1 production. In the periphery, androgens enhance the action of GH. The differential effects of estrogens and androgens influence the dose of GH replacement in patients with hypopituitarism on concomitant treatment with sex steroids.Where possible, a non-oral route of estrogen replacement is recommended for optimising cost-benefit of GH replacement in women with GH deficiency. Adequate androgen replacement in conjunction with GH replacement is required to achieve the full anabolic effect in men with hypopituitarism.

show abstract

Estrogen Replacement in Women of Fertile Years with Hypopituitarism

Abstract: Background: What form of estrogen to prescribe a young hypopituitary woman with gonadal failure remains an open question despite evidence that oral estrogen therapy induces GH resistance and an increase in fat mass.

Cited by 55 publications

References 36 publications

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

GH replacement in adults: interactions with other pituitary hormone deficiencies and replacement therapies

Hypothalamic involvement and insufficient sex steroid supplementation are associated with low bone mineral density in women with childhood onset craniopharyngioma

Sex steroids and the GH axis: Implications for the management of hypopituitarism

Contact Info

Product

Resources

About