Exposure to Exogenous Female Sex Hormones is Associated with Increased Risk of Orbito-Cranial Meningioma in Females: A Case-Control Study

Supartoto, Agus; Mahayana, Indra Tri; Christine, Reinne Natali; Suhardjo,; Agni, Angela Nurini; Sasongko, Mohammad Bayu

doi:10.4172/2324-8599.1000183

“…We used the same study population to address multiple study questions and tested multiple hypotheses at the same time. This study addressed completely different study questions and in fact, is a continuation of our previous works that has been previously published (21). We have described and cited appropriately to our previous publication anywhere indicated.…”

Section: Discussionmentioning

confidence: 59%

“…There are no studies available from the literature that provide direct comparisons with our findings. First, we have previously demonstrated in this population that longer exposure of exogenous progesterone was correlated with higher risk of meningioma (21). This was in line with previous study by Harland and associates showing that exogenous progesterone has also been shown to be associated with higher risk of recurrent meningioma (22).…”

Section: Discussionmentioning

confidence: 84%

“…The baseline characteristics of 115 subjects who participated are shown in Table 1, and has been presented elsewhere (21). In general, cases had very similar background in terms of age, occupation, monthly income and marital status compared to controls.…”

Section: Resultsmentioning

confidence: 99%

“…Our study was a case-control study that involves 115 females, 40 cases who diagnosed with orbito-cranial meningioma and 75 controls of healthy, that has been presented in previous study (21). Definition of cases and controls has been described previously (21). Cases were recruited consecutively from three hospital located in Yogyakarta, Indonesia from 2010 until 2014.…”

Section: Methodsmentioning

confidence: 99%

“…The interview and risk factors assessment have also been detailed elsewhere (21). All of study subjects underwent thorough face-to-face or telephone interview.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females

Supartoto

¹

,

Sasongko

²

,

Respatika

³

et al. 2019

Self Cite

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Background: The pathogenesis of meningioma in females and its association with exogenous progesterone is remained unclear. This study was aimed to examine expression of Progesterone receptor (PR) and Neurofibromatosis-2 (NF2) and assess their relationships to history of exogenous progesterone use and risk of meningioma.Methods: Our study was a case-control study that involves 115 females, 40 cases who diagnosed with orbito-cranial meningioma and 75 controls of healthy, that has been presented in previous study. The demographic characteristics, reproductive factors, and history of progesterone use were obtained in–depth face-to-face interviews. PR and NF2 mRNA were assessed by real-time quantitative polymerase chain reaction (RT-qPCR) on serum specimens.Results: The mean age of participants in cases vs. controls were 46.6 ± 6.2 vs. 46.5 ± 7.45 (P = 0.969). The expression of PR and NF2 in cases was significantly lower than in controls. The longer duration of progesterone exposure was significantly associated with lower expression of PR and NF2. Significant association between lower expression of PR (OR 11.7; 95% CI 4.17–32.9; P < 0.001 comparing the lowest quartile vs. 3 highest quartile of PR) and NF2 (OR 4.23; 95% CI 1.85–9.67; P = 0.001 comparing the 2 lowest quartiles vs. 2 highest quartiles) with increased risk of meningioma were also reported.Conclusion: In this study we showed that the longer the exposure to exogenous progesterone, the lower the expression of PR and NF2 mRNA in the serum. Low expression of PR and NF2 were associated with higher risk of meningioma, suggesting that low PR expression and inactivation of NF2 might play a key role in progesterone-associated meningioma tumorigenesis and may be potential clinical marker for females at higher risk of meningioma.

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Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Samoyeau

¹

,

Provost

²

,

Roux

³

et al. 2022

J Neurooncol

9

0

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Purpose: To report the results of systematic meningioma screening program implemented by French authorities in patients exposed to progestin therapies (cyproterone (CPA), nomegestrol (NA), and chlormadinone (CMA) acetate).Methods: We conducted a prospective monocentric study on patients who, between September 2018 and April 2021, underwent standardized MRI (injection of gadolinium, then a T2 axial FLAIR and a 3D-T1 gradient-echo sequence) for meningioma screening.Results: Of the 210 included patients, 15 (7.1%) had at least one meningioma; seven (7/15, 47%) had multiple meningiomas. Meningiomas were more frequent in older patients and after exposure to CPA (13/103, 13%) compared to NA (1/22, 4%) or CMA (1/85, 1%; P=0.005). After CPA exposure, meningiomas were associated with longer treatment duration (median=20 vs 7 years, P=0.001) and higher cumulative dose (median=91 g vs. 62 g, P=0.014). Similarly, their multiplicity was associated with higher dose of CPA (median=244 g vs 61 g, P=0.027). Most meningiomas were ≤1 cm 3 (44/58, 76%) and were convexity meningiomas (36/58, 62%). At diagnosis, patients were non-symptomatic, and all were managed conservatively. Among 14 patients with meningioma who stopped progestin exposure, meningioma burden decreased in 11 (79%) cases with no case of progression during MR follow-up.Conclusion: Systematic MR screening in progestin-exposed patients uncovers small and multiple meningiomas, which can be managed conservatively, decreasing in size after progestin discontinuation. The high rate of meningiomas after CPA exposure reinforces the need for systematic screening. For NA and CMA, further studies are needed to identify patients most likely to bene t from screening.needing an invasive treatment. This risk was higher risk for CPA than CMA and NA, was dose-dependent, and a decreased after progestin discontinuation [29,30]. Recently, a meta-analysis con rmed the association between CPA and meningioma and validated the imaging-requirement before undergoing . These studies led to French recommendations of systematic MR screening in patients exposed to progestin[32]: from September 2018 for CPA, and June 2020 for CMA and NA[33].This national systematic screening as well as the information given to clinicians and patients resulted in a sudden increase of MRI examinations in asymptomatic patients. However, these screened patients were not targeted in previous studies that investigated mainly symptomatic, often surgically-treated meningiomas. Therefore, the percentage of asymptomatic meningiomas in the screened population and their type of management, as well as the possibility to detect other brain lesions (incidental or associated to progestin) is still uncertain. Hence, our aim is to report the yield of the real-life screening of meningioma in such population, in particular their prevalence, MRI characteristics and the care they received in our neurosurgical center. Methods Study design and populationWe conducted a prospective monocentric cohort study including consecutive progestin-exp...

show abstract

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Samoyeau

¹

,

Provost

²

,

Roux

³

et al. 2022

Preprint

0

View full text Add to dashboard Cite

Purpose: To report the results of systematic meningioma screening program implemented by French authorities in patients exposed to progestin therapies (cyproterone (CPA), nomegestrol (NA), and chlormadinone (CMA) acetate).Methods: We conducted a prospective monocentric study on patients who, between September 2018 and April 2021, underwent standardized MRI (injection of gadolinium, then a T2 axial FLAIR and a 3D-T1 gradient-echo sequence) for meningioma screening.Results: Of the 210 included patients, 15 (7.1%) had at least one meningioma; seven (7/15, 47%) had multiple meningiomas. Meningiomas were more frequent in older patients and after exposure to CPA (13/103, 13%) compared to NA (1/22, 4%) or CMA (1/85, 1%; P=0.005). After CPA exposure, meningiomas were associated with longer treatment duration (median=20 vs 7 years, P=0.001) and higher cumulative dose (median=91 g vs. 62 g, P=0.014). Similarly, their multiplicity was associated with higher dose of CPA (median=244 g vs 61 g, P=0.027). Most meningiomas were ≤1 cm3 (44/58, 76%) and were convexity meningiomas (36/58, 62%). At diagnosis, patients were non-symptomatic, and all were managed conservatively. Among 14 patients with meningioma who stopped progestin exposure, meningioma burden decreased in 11 (79%) cases with no case of progression during MR follow-up.Conclusion: Systematic MR screening in progestin-exposed patients uncovers small and multiple meningiomas, which can be managed conservatively, decreasing in size after progestin discontinuation. The high rate of meningiomas after CPA exposure reinforces the need for systematic screening. For NA and CMA, further studies are needed to identify patients most likely to benefit from screening.

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Exposure to Exogenous Female Sex Hormones is Associated with Increased Risk of Orbito-Cranial Meningioma in Females: A Case-Control Study

Cited by 5 publications

References 0 publications

Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females

Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

Meningioma in patients exposed to progestin drugs: results from a real-life screening program

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