Fertility treatment is associated with multiple meningiomas and younger age at diagnosis

Abstract

Purpose: Meningiomas are more common in females and 70-80% express the progesterone receptor, raising the possibility that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female meningioma patients. Methods: A retrospective review (2015-2018) was performed of female patients with meningioma, and those with prior fertility treatment were compared to those without fertility treatment using standard statistical methods. Results: Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs 57.3 yrs, p = 0.0135, 2-tailed T-test), and on multivariate analysis were more likely to have multiple meningiomas (OR: 4.97, 95% CI: 1.4-18.1, p = 0.0154) and convexity/falx meningiomas (OR: 4.45, 95% CI: 1.7-11.5, p = 0.0021). Conclusions: Patients in this cohort with a history of fertility treatment were more likely to present at a younger age and have multiple and convexity/falx meningiomas, emphasizing the importance of taking estrogen/progesterone exposure history when evaluating patients with

Meningiomas and cyproterone acetate: a retrospective, monocentric cohort of 388 patients treated by surgery or radiotherapy for intracranial meningioma

“…hormone replacement therapy [12][13][14][31][32][33][34], oral contraceptives or medically-assisted reproduction treatment [35]. Establishing a link between hormone treatment (excluding CPA) and the risk of meningiomas therefore remains difficult.…”

Regression of Multiple Meningiomas after Discontinuation of Chronic Hormone Therapy: A Case Report

“…While this patient's multiple meningiomas are not definitively connected to chronic progesterone use, her young age, finding of multiple meningiomas, and especially their subsequent regression upon cessation of exogenous hormone use do support this notion. 23,24 Considering the relationship between hormone exposure and meningioma and the increased risk endometriosis confers, patients with endometriosis may benefit from screening prior to initiating hormone-based therapy and/or serial imaging throughout treatment. Further investigation is required to clearly understand this relationship and how to mitigate potential risks.…”

“…23 An institutional experience of history of fertility treatment in the setting of meningioma found patients with a history of any type of hormonal fertility treatments similarly presented at a younger mean age compared with those who had not (51.8 vs. 57.3 years), and on multivariate analysis were more likely to have multiple meningiomas (OR: 4.97, 95% CI: 1.4-18.1) and convexity/falx meningiomas (OR: 4.45, 95% CI: 1.7-11.5). 24 Lastly, meningioma in the setting of gender reassignment therapy has been limited to case reports 8,21,25,26 including a recent report of two maleto-female transsexual males on long-term hormone replacement therapy who both presented with visual disturbances leading to the discovery of multiple meningiomas, including parasellar meningiomas. 25…”

Discovering the Molecular Landscape of Meningioma: The Struggle to Find New Therapeutic Targets

“…Molecular analysis allowed to clarify the biological landscape of two other types of meningiomas, with possible therapeutic implications: radiation-induced and progestinassociated meningiomas [58,59]. Progestine-associated meningiomas, which are generally grade 1 and 2, present NF2 alteration only in 7.5% of cases, while a PIK3CA mutation can be found in 35% of cases [59,60]. Otherwise, radiation-induced meningiomas often present NF2 alterations and deficit of DNA double strand repair genes [61].…”