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Premenstrual disorders and PMDD - a review 心理问题和激素疗法
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101858
Emily Cary (Honorary Senior Lecturer) , Paul Simpson (Consultant Gynaecologist)

Defining, diagnosing and managing premenstrual disorders (PMDs) remains a challenge both for general practitioners and specialists. Yet these disorders are common and can have an enormous impact on women. PMDD (premenstrual dysphoric disorder), one severe form of PMD, has a functional impact similar to major depression yet remains under-recognised and poorly treated. The aim of this chapter is to give some clarity to this area, provide a framework for non-specialists to work towards, and to stress the importance of MDT care for severe PMDs, including PMDD.

对于全科医生和专科医生来说,经前期紊乱症(PMD)的定义、诊断和管理仍然是一项挑战。然而,这些疾病很常见,而且会对女性产生巨大影响。PMDD(经前期情感障碍)是 PMD 的一种严重形式,其功能性影响类似于重度抑郁症,但仍未得到充分认识和治疗。本章旨在澄清这一领域,为非专科医生提供一个工作框架,并强调多学科小组护理对包括 PMDD 在内的严重 PMD 的重要性。
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引用次数: 0
Oestrogen-based therapies for menopausal symptoms 治疗更年期症状的雌激素疗法
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101789
Abbie Laing, Tim Hillard

Purpose

To summarise the dosing options, regimens, pharmacokinetics, risks and benefits of oestrogen-based therapies for the treatment of menopausal symptoms.

Methods

A review of the literature was undertaken using multiple databases. Randomised trials, observational studies, meta-analyses and review papers were included.

Results

Multiple systemic preparations of oestrogen exist and all appear comparable in terms of efficacy. They differ by pharmacokinetics and those preparations that avoid hepatic metabolism have a lower risk profile in general although their use can be limited by skin barriers or patient acceptability. All vaginal oestrogen treatments are comparable in efficacy and have not been associated with any health risks. Side-effects between all preparations differ.

Conclusions

With regards to oestrogen treatments there is not a one size fits all. Multiple treatments are available and a clinician’s role is to guide and help women make evidence based, unbiased and informed choices.

目的 总结治疗更年期症状的雌激素疗法的剂量选择、疗程、药代动力学、风险和益处。结果目前存在多种雌激素全身制剂,就疗效而言,它们似乎都具有可比性。它们的药代动力学各不相同,避免肝脏代谢的制剂一般风险较低,但其使用可能受到皮肤屏障或患者接受度的限制。所有阴道雌激素疗法的疗效都相当,而且没有任何健康风险。所有制剂的副作用各不相同。有多种治疗方法可供选择,临床医生的职责是指导和帮助妇女做出基于证据、公正和知情的选择。
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引用次数: 0
Bone health and menopause: Osteoporosis prevention and treatment 骨骼健康与更年期骨质疏松症的预防和治疗
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101782
Tobie J. de Villiers MBChB, MMED (O&), FCOG (SA), FRCOG (Consultant Gynaecologist)

A continuous process of bone turnover is central to bone health and strength. If bone resorption exceeds bone formation, bone strength deteriorates with resultant fractures. Osteoporosis is defined by a fracture or bone mineral density. The lack of ovarian estrogen after menopause causes a significant loss in bone strength, placing women at higher risk of osteoporosis. The probability of future fractures can be calculated by identifying risk factors in all menopausal women. Preventive action starts with a bone-friendly lifestyle. The need for and type of interventive medication can best be determined by classifying fracture risk as low, high, or very high using a combination of fracture history, bone mineral density, 10-year fracture probability or country-specific values. As osteoporosis is an incurable disease, treatment should be seen as a lifelong strategy consisting of the correct sequencing of available bone-specific drugs and appropriate drug-free periods when applicable.

持续的骨转换过程是骨骼健康和强度的核心。如果骨吸收超过骨形成,骨强度就会下降,从而导致骨折。骨质疏松症的定义是骨折或骨矿物质密度。绝经后卵巢雌激素的缺乏会导致骨强度显著下降,使女性患骨质疏松症的风险更高。通过识别所有更年期女性的风险因素,可以计算出未来发生骨折的概率。预防措施从对骨骼有益的生活方式开始。根据骨折史、骨质密度、10 年骨折概率或特定国家的数值,将骨折风险分为低、高或极高,从而确定是否需要干预性药物以及干预性药物的类型。由于骨质疏松症是一种无法治愈的疾病,因此应将治疗视为一种终身策略,包括正确安排现有骨质特异性药物的使用顺序,并在适当的情况下安排适当的无药期。
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引用次数: 0
Post cancer care in women with an increased risk of malignancy or previous malignancy: The use of hormone replacement therapy and alternative treatments 恶性肿瘤风险增加或曾患恶性肿瘤妇女的癌症后护理:激素替代疗法和替代疗法的使用。
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101854
Jenifer Sassarini (Consultant in Gynaecology and Obstetrics) , Mary Ann Lumsden (Hon Prof of Gynaecology and Medical Education)
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引用次数: 0
Androgen-based therapies in women 妇女的雄激素疗法
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101783
Kath Whitton (Obstetrician, Gynaecologist, Fertility Specialist) , Rodney Baber (Clinical Professor of Obstetrics and Gynaecology)

Androgens play a key biological role in libido and sexual arousal in women, and knowledge about their complex role in other systems remains ambiguous and incomplete. This narrative review examines the role of endogenous androgens in women’s health throughout the life span before focusing on evidence surrounding the use of androgen-based therapies to treat postmenopausal women. The role of testosterone as a therapeutic agent in women continues to attract controversy as approved preparations are rare, and use of off-label and compounded formulations is widespread. Despite this androgen therapy has been used for decades in oral, injectable, and transdermal formulations. Responses to androgen therapy have been demonstrated to improve aspects of female sexual dysfunction, notably hypoactive sexual desire disorder, in a dose related manner. Substantial research has also been conducted into the role of androgens in treating aspects of the genitourinary syndrome of menopause (GSM). Evidence for benefits beyond these is mixed and more research is required regarding long-term safety. However, It remains biologically plausible that androgens will be effective in treating hypoestrogenic symptoms related to menopause, either through direct physiological effects or following aromatization to estradiol throughout the body.

雄激素在女性的性欲和性唤起中发挥着关键的生物学作用,而关于雄激素在其他系统中的复杂作用的知识仍然模糊不清、不完整。这篇叙述性综述探讨了内源性雄激素在女性一生中的健康中所起的作用,然后重点介绍了使用雄激素疗法治疗绝经后妇女的相关证据。睾酮作为一种治疗药物在女性中的作用一直备受争议,因为获得批准的制剂很少,而标签外制剂和复方制剂的使用非常普遍。尽管如此,口服、注射和透皮制剂的雄激素疗法已使用了几十年。事实证明,雄激素疗法可以改善女性性功能障碍,尤其是性欲减退,而且与剂量有关。此外,还对雄激素在治疗更年期泌尿生殖系统综合征(GSM)方面的作用进行了大量研究。除此以外,其他益处的证据不一,还需要对长期安全性进行更多研究。不过,从生物学角度看,雄激素通过直接的生理作用或在体内芳香化为雌二醇后,仍可有效治疗与更年期有关的雌激素过低症状。
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引用次数: 0
Sexual health and contraception in the menopause journey 更年期之旅中的性健康和避孕。
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101822
Laura Cucinella (Gynecologist, Research Assistant in Obstetrics & Gynecology) , Lara Tiranini (Gynecologist, Research Assistant in Obstetrics & Gynecology) , Rossella E. Nappi (Gynecologist and Endocrinologist, Professor of Obstetrics & Gynecology)

Women may experience changes in sexuality across menopause, because at this step in life hormone deficiency interacts with several determinants in a bio-psycho-social perspective. Healthcare providers should inform women about menopause impact on sexuality and be proactive during consultation in disclosing sexual concerns that would require a targeted assessment. Sexual symptoms become more frequent as women age, but they do not always translate into sexual dysfunction diagnosis, for which distress is required. It is important to recognize conditions that may increase the risk of dysfunctional response to menopause challenges in order to promote sexual longevity through counselling and specific management. In this review, we report key elements for a comprehensive assessment of sexual health around menopause, with a focus on genitourinary syndrome of menopause (GSM) and hypoactive sexual desire disorder (HSDD), representing well identified clinical conditions affecting sexuality at midlife and beyond. We also address the issue of contraception across the menopausal transition, highlighting risks and benefits, and possible implications on sexual function.

女性可能会在整个更年期经历性行为的变化,因为在生命的这一步,激素缺乏与生物-心理-社会角度的几个决定因素相互作用。医疗保健提供者应告知女性更年期对性行为的影响,并在咨询期间积极主动地披露需要进行有针对性评估的性问题。随着女性年龄的增长,性症状变得越来越频繁,但它们并不总是转化为性功能障碍的诊断,这需要痛苦。重要的是要认识到可能增加对更年期挑战反应失调风险的情况,以便通过咨询和具体管理来促进性寿命。在这篇综述中,我们报告了全面评估更年期性健康的关键因素,重点是更年期泌尿生殖系统综合征(GSM)和低活动性性欲障碍(HSDD),它们代表了影响中年及以后性行为的公认临床条件。我们还讨论了整个更年期过渡期的避孕问题,强调了风险和益处,以及对性功能的可能影响。
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引用次数: 0
Progestogens for endometrial protection in combined menopausal hormone therapy: A systematic review 更年期激素联合疗法中用于保护子宫内膜的孕激素:系统综述
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2023.101815
Petra Stute (Deputy Head Gynecological Endocrinology and Reproductive Medicine) , Linus Josef Walker (Medical Doctoral Student) , Astrid Eicher (Medical Doctoral Student) , Elena Pavicic (Medical Doctoral Student) , Argyrios Kolokythas (Gynecologic Reproductive Endocrinology and Infertility Fellow) , Susanne Theis (Senior Physician Gynecological Endocrinology and Reproductive Medicine) , Marc von Gernler (Information Specialist) , Michael von Wolff (Head Gynecological Endocrinology and Reproductive Medicine) , Sabrina Vollrath (Senior Physician Gynecological Endocrinology and Reproductive Medicine)

Menopausal women with an intact uterus choosing estrogens for menopausal symptom relief require a progestogen for endometrial protection. The aim of this systematic review was to evaluate the risks of endometrial hyperplasia resp. malignancy with different progestogens used in combined MHT. Overall, 84 RCTs were included. We found that 1) most studies were done with NETA, followed by MPA, MP and DYD and LNG, 2) most progestogens were only available as oral formulations, 3) the most frequently studied progestogens (oral MP, DYD, MPA, oral and transdermal NETA, transdermal LNG) were assessed in continuously as well as in sequentially combined MHT regimens, 4) FDA endometrial safety criteria were only fulfilled for some progestogen formulations, 5) most studies demonstrated endometrial protection for the progestogen dose and time period examined. However, 6) study quality varied which should be taken into account, when choosing a combined MHT, especially if off-label-use is chosen.

子宫完整的更年期妇女在选择雌激素缓解更年期症状时,需要使用孕激素来保护子宫内膜。本系统综述旨在评估在联合 MHT 中使用不同孕激素导致子宫内膜增生和恶性肿瘤的风险。共纳入了 84 项 RCT 研究。我们发现:1)大多数研究都是针对 NETA 进行的,其次是 MPA、MP、DYD 和 LNG;2)大多数孕激素只有口服制剂;3)最常研究的孕激素(口服 MP、DYD、MPA、口服和透皮 NETA、透皮 LNG、MP、DYD 和 LNG)都是评估子宫内膜增生和恶性肿瘤风险的药物、4)只有部分孕激素制剂符合美国食品及药物管理局的子宫内膜安全性标准,5)大多数研究表明,在所研究的孕激素剂量和时间段内,对子宫内膜有保护作用。然而,6)研究质量参差不齐,在选择联合 MHT 时应加以考虑,尤其是在标签外使用的情况下。
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引用次数: 0
Primary hyperparathyroidism 原发性甲状旁腺功能亢进症
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-01-01 DOI: 10.1016/j.beem.2018.09.013
Barbara C. Silva (Professor of Medicine) , Natalie E. Cusano (Assistant Professor of Medicine) , John P. Bilezikian (Professor of Medicine, Professor of Pharmacology)

Primary hyperparathyroidism (PHPT), the most common cause of hypercalcemia, is most often identified in postmenopausal women with hypercalcemia and parathyroid hormone (PTH) levels that are either frankly elevated or inappropriately normal. The clinical presentation of PHPT includes three phenotypes: target organ involvement of the renal and skeletal systems; mild asymptomatic hypercalcemia; and more recently, high PTH levels in the context of persistently normal albumin-corrected and ionized serum calcium values. The factors that determine which of these three clinical presentations is more likely to predominate in a given country include the extent to which biochemical screening is employed, the prevalence of vitamin D deficiency, and whether a medical center or practitioner tends to routinely measure PTH levels in the evaluation of low bone density or frank osteoporosis. When biochemical screening is common, asymptomatic primary hyperparathyroidism is the most likely form of the disease. In countries where vitamin D deficiency is prevalent and biochemical screening is not a feature of the health care system, symptomatic disease with skeletal abnormalities is likely to predominate. Finally, when PTH levels are part of the evaluation for low bone mass, the normocalcemic variant is seen. Guidelines for surgical removal of hyperfunctioning parathyroid tissue apply to all three clinical forms of the disease. If guidelines for surgery are not met, parathyroidectomy can also be an appropriate option if there are no medical contraindications to surgery. In settings where either the serum calcium or bone mineral density is of concern, and surgery is not an option, pharmacological approaches are available and effective. Referencing in this article the most current published articles, we review the different presentations of PHPT, with particular emphasis on recent advances in our understanding of target organ involvement and management.

原发性甲状旁腺功能亢进症(PHPT)是导致高钙血症的最常见原因,多见于绝经后妇女,她们常伴有高钙血症和甲状旁腺激素(PTH)水平明显升高或异常正常。PHPT 的临床表现包括三种表型:肾脏和骨骼系统的靶器官受累;轻度无症状高钙血症;以及最近出现的在白蛋白校正和离子化血清钙值持续正常的情况下出现高 PTH 水平。在特定国家,决定这三种临床表现中哪一种更有可能占主导地位的因素包括生化筛查的应用程度、维生素 D 缺乏症的流行程度,以及医疗中心或医生在评估低骨密度或骨质疏松症时是否倾向于常规测量 PTH 水平。当生化筛查很普遍时,无症状的原发性甲状旁腺功能亢进症是最可能的疾病形式。在维生素D缺乏症盛行的国家,生化筛查并不是医疗保健系统的一大特色,有症状并伴有骨骼异常的疾病很可能占主导地位。最后,当 PTH 水平是低骨量评估的一部分时,就会出现正常钙血症变异型。手术切除功能亢进的甲状旁腺组织的指南适用于所有三种临床形式的疾病。如果不符合手术指南,在没有手术禁忌症的情况下,甲状旁腺切除术也是一种合适的选择。在血清钙或骨矿物质密度令人担忧而又无法选择手术的情况下,药物治疗是可行且有效的方法。本文参考了最新发表的文章,回顾了 PHPT 的不同表现,特别强调了我们对靶器官受累和管理的最新认识。
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引用次数: 0
Traumatic brain injury, abnormal growth hormone secretion, and gut dysbiosis 创伤性脑损伤,生长激素分泌异常,肠道失调。
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 DOI: 10.1016/j.beem.2023.101841
Peyton A. Armstrong (Medical Student) , Navneet Venugopal (Medical Student) , Traver J. Wright (Assistant Professor) , Kathleen M. Randolph (Program Manager) , Richard D. Batson (Executive Director) , Kevin C.J. Yuen (Professor and Medical Director) , Brent E. Masel (Clinical Professor) , Melinda Sheffield-Moore (Professor, Senior Vice President and Dean of the UTMB Graduate School of Biomedical Sciences) , Randall J. Urban (Professor and the UTMB Chief Research Officer , Richard B. Pyles Professor)

The gut microbiome has been implicated in a variety of neuropathologies with recent data suggesting direct effects of the microbiome on host metabolism, hormonal regulation, and pathophysiology. Studies have shown that gut bacteria impact host growth, partially mediated through the growth hormone (GH)/insulin-like growth factor 1 (IGF-1) axis. However, no study to date has examined the specific role of GH on the fecal microbiome (FMB) or the changes in this relationship following a traumatic brain injury (TBI). Current literature has demonstrated that TBI can lead to either temporary or sustained abnormal GH secretion (aGHS). More recent literature has suggested that gut dysbiosis may contribute to aGHS leading to long-term sequelae now known as brain injury associated fatigue and cognition (BIAFAC). The aGHS observed in some TBI patients presents with a symptom complex including profound fatigue and cognitive dysfunction that improves significantly with exogenous recombinant human GH treatment. Notably, GH treatment is not curative as fatigue and cognitive decline typically recur upon treatment cessation, indicating the need for additional studies to address the underlying mechanistic cause.

肠道微生物群与多种神经病理有关,最近的数据表明,肠道微生物群对宿主代谢、激素调节和病理生理有直接影响。研究表明,肠道细菌影响宿主生长,部分通过生长激素(GH)/胰岛素样生长因子1 (IGF-1)轴介导。然而,迄今为止还没有研究检查生长激素对粪便微生物组(FMB)的特定作用或创伤性脑损伤(TBI)后这种关系的变化。目前的文献表明,脑外伤可导致暂时或持续的生长激素分泌异常(aGHS)。最近的文献表明,肠道生态失调可能导致aGHS导致长期后遗症,现在称为脑损伤相关疲劳和认知(BIAFAC)。在一些TBI患者中观察到的aGHS表现为复杂的症状,包括深度疲劳和认知功能障碍,外源性重组人生长激素治疗显著改善。值得注意的是,生长激素治疗不能治愈,因为疲劳和认知能力下降通常在治疗停止后复发,这表明需要进一步的研究来解决潜在的机制原因。
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引用次数: 0
Differences between bone health parameters in adults with acromegaly and growth hormone deficiency: A systematic review 成人肢端肥大症和生长激素缺乏症骨健康参数的差异:一项系统综述。
IF 7.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2023-12-01 DOI: 10.1016/j.beem.2023.101824
Pamela U. Freda (Professor of Medicine)

Preserving bone health is an important goal of care of patients with acromegaly and growth hormone deficiency (GHD). Both disorders are associated with compromised bone health and an increased risk of fracture. However, parameters of bone health that are routinely used to predict fractures in other populations, such as aBMD measured by DXA, are unreliable for this in acromegaly and GHD. Additional methodologies need to be employed to assess bone health in these patients. This review summarizes available data on the effects of acromegaly and GHD on parameters of bone health such as aBMD, volumetric bone mineral density (vBMD) and microarchitecture assessed by HRpQCT and other techniques, trabecular bone score (TBS) and fracture assessment. More research is needed to identify reliable predictors of fracture risk and to determine how best to screen for and treat those patients at risk so that bone health is optimized in these patients.

保护骨骼健康是肢端肥大症和生长激素缺乏症(GHD)患者护理的重要目标。这两种疾病都与骨骼健康受损和骨折风险增加有关。然而,通常用于预测其他人群骨折的骨健康参数,如DXA测量的aBMD,在肢端肥大症和GHD中是不可靠的。需要采用其他方法来评估这些患者的骨骼健康状况。这篇综述总结了关于肢端肥大症和GHD对骨健康参数的影响的现有数据,如aBMD、体积骨密度(vBMD)和通过HRpQCT和其他技术评估的微结构、骨小梁评分(TBS)和骨折评估。需要更多的研究来确定骨折风险的可靠预测因素,并确定如何最好地筛查和治疗这些有风险的患者,从而优化这些患者的骨骼健康。
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引用次数: 0
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