goserelin and Leiomyomatosis

Gonadotropin Hormone Releasing Hormone agonists (GnRHa) produce an acute decline in ovarian hormone production leading to a 'pseudo' menopause. This is therapeutically useful in the management of a variety of gynaecological conditions but also serves as a powerful model to study the effects of ovarian hormones on cognition. Animal and human behavioral studies report that memory is particularly sensitive to the effects ovarian hormone suppression (e.g. post GnRHa). Further, it has recently been reported that ovariectomy in young women increases the risk of cognitive impairment in later life. However, the underlying brain networks and/or stages of memory processing that might be modulated by acute ovarian hormone suppression remain poorly understood. We used event-related fMRI to examine the effect of GnRHa on visual working memory (VWM). Neuroimaging outcomes from 17 pre-menopausal healthy women were assessed at baseline and 8 weeks after GnRHa treatment. Seventeen matched wait-listed volunteers served as the control group and were assessed at similar intervals during the late follicular phase of the menstrual cycle. We report GnRHa was associated with attenuation of left parahippocampal (BA 35) and middle temporal gyri (BA 21 ,22, 39) activation, with a significant group-by-time interaction at left precuneus (BA 7) and posterior cingulate cortex (PCC) (BA 31) at encoding, and with cerebellar activation at recognition in the context of unimpaired behavioral responses. Our study suggests that acute ovarian hormone withdrawal following GnRHa, and perhaps at other times, (e.g. following surgical menopause and postpartum) alters the neural circuitry underlying performance of VWM.

Topics: Adult; Antineoplastic Agents, Hormonal; Brain; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Leiomyomatosis; Magnetic Resonance Imaging; Memory; Pattern Recognition, Visual; Radiography; Space Perception; Uterine Neoplasms

To compare uterine size reduction obtained with three monthly subcutaneous injections of 3.6 mg of goserelin versus a single subcutaneous injection of 10.8 mg.. Prospective, randomized clinical trial (Canadian Task Force classification I).. Department of Gynecology and Obstetrics at the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo.. Forty-five premenopausal women with uterine leiomyomas and uterine size greater than 600 cm(3) randomized to one of two groups.. Group A: 23 women received three monthly subcutaneous 3.6-mg doses of goserelin. Group B: 22 women received a single subcutaneous injection of 10.8 mg of goserelin. Follicle-stimulating hormone (FSH), estradiol, and hemoglobin levels were measured monthly. After 3 months, uterine size was determined by transvaginal and/or abdominal ultrasound.. In group A, mean reduction of uterine size was 43% (426 cm(3)) at the end of treatment. In Group B, mean reduction of uterine size was 54% (494 cm(3)). Serum levels of FSH and estradiol were in postmenopausal range during treatment. Hemoglobin level improvement was equivalent in both groups.. Use of single injection of 10.8 mg of goserelin promoted significantly greater reduction in uterine size than three monthly 3.6-mg injections in patients with voluminous uterine leiomyomas.

Topics: Adult; Antineoplastic Agents, Hormonal; Dose-Response Relationship, Drug; Estradiol; Female; Follicle Stimulating Hormone; Goserelin; Hemoglobins; Humans; Leiomyomatosis; Prospective Studies; Uterine Neoplasms

The gonadotrophin-releasing hormone (GnRH) agonists are an efficacious medical approach for the management of both dysfunctional uterine bleeding (DUB) and uterine fibroids. However, due to the long-term effects of GnRH agonists on bone mass, their use is restricted to short courses. Add-back hormone replacement therapy (HRT) is one strategy that could minimise the hypo-oestrogenic effects of GnRH agonists, without nullifying their therapeutic effects. In one study of add-back therapy with cyclical oestradiol/norgestrol in combination with Zoladex (goserelin acetate) in women with subjective DUB, the duration of menstruation, the number of days of heavy bleeding and objective blood loss were all significantly (P < 0.001) reduced. There was also significant (P < 0.001) symptomatic improvement. Furthermore, in 51 patients with symptomatic uterine fibroids, combined oestrogen/progestogen given for 21 months after initial GnRH agonist treatment for 3 months did not promote fibroid regrowth. In contrast, in women randomised to progestogen only, there was a gradual increase in uterine volume. The combination of GnRH agonists and add-back HRT appears beneficial for women with either DUB or fibroids.

Topics: Adult; Climacteric; Drug Combinations; Drug Therapy, Combination; Estradiol; Estrogen Replacement Therapy; Female; Goserelin; Headache; Humans; Leiomyomatosis; Medroxyprogesterone Acetate; Menorrhagia; Middle Aged; Norgestrel; Progestins; Treatment Outcome; Uterine Neoplasms

Intravenous leiomyomatosis with cardiac extension is a rare entity. The case of a 49-year-old patient is described: she was operated on for intracaval intra-atrial leiomyomatosis. After an incomplete procedure (the tumour appeared not totally resectable), the patient was treated for a period of three years with a GnRH-analogue, whereafter the patient was doing clinically well and the tumour, although it regained some growth, was in a stable situation. This new strategy seems of certain importance to the surgeon, as it carries an alternative to a high-risk reoperation. To our knowledge, this is the first description of such a combined therapeutical approach.

Topics: Antineoplastic Agents, Hormonal; Combined Modality Therapy; Female; Goserelin; Heart Atria; Heart Neoplasms; Humans; Leiomyomatosis; Middle Aged; Vascular Neoplasms

Clinical and pathological changes of the mammary gland have been studied in 64 women affected by symptomatic Benign Breast Disease (BBD) coexisting with endometriosis or uterine leiomyomata. These patients were rendered hypoestrogenic by subcutaneous administration of the LH-RH analogue Goserelin depot [D-ser (tBu)6 Aza-Gly10-GnRH (ICI118630)] performed every 28 days, for six months. They were evaluated clinically and ultrasonographically before and after treatment to find possible changes of BBD as well as of endometriosis or uterine leiomyomata. Mammary biopsies were performed before and after treatment in all the patients to study the changes of EGF-R expression. Results showed that clinical improvement is accompanied with a reduction of EGF-R expression.

Topics: Antineoplastic Agents, Hormonal; Endometriosis; ErbB Receptors; Female; Goserelin; Humans; Leiomyomatosis; Uterine Diseases; Uterine Neoplasms

Topics: Adult; Antineoplastic Agents, Hormonal; Endometriosis; Female; Goserelin; Humans; Leiomyomatosis; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Uterine Neoplasms

Degenerative changes are encountered relatively frequently in uterine leiomyomas. Morphologic changes within leiomyomas, particularly necrosis and alterations in cellularity, have been described following treatment with gonadotrophin releasing hormone analogue, but the effects of this form of treatment on the morphology of the normal myometrium are less well documented. A case is reported of a 42 year old woman with a history of menorrhagia in whom a combination of degenerative and iatrogenic changes resulted in a histological appearance resembling diffuse leiomyomatosis.

Topics: Adult; Female; Goserelin; Humans; Leiomyomatosis; Myometrium; Uterine Neoplasms

Benign metastasising leiomyoma is a rare disease occurring predominantly in women of childbearing age and is hormonally influenced. The response of the disease to the luteinising hormone releasing hormone analogue goserelin is reported.

Topics: Adult; Antineoplastic Agents, Hormonal; Female; Goserelin; Humans; Leiomyomatosis; Lung Neoplasms