Treatment of severe postmenopausal endometriosis with an aromatase inhibitor
Treatment of severe postmenopausal endometriosis with an aromatase inhibitor
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DOI：
10.1016/s0015-0282(98)00022-3
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发表时间：
1998-04-01
影响因子：
6.7
通讯作者：
Bulun, SE
中科院分区：
文献类型：
--
作者：
Takayama, K;Zeitoun, K;Bulun, SE
目的：治疗1例复发的绝经后子宫内膜异位症。设计：病例报告。地点：德克萨斯大学西南医学中心(德克萨斯州达拉斯)。患者(S)：57岁，女性，子宫切除和双侧输卵管卵巢切除术后复发。干预(S)：口服阿那曲唑(一种芳香酶抑制剂)(1 mg/d)和元素钙(1.5g/d)，疗程9个月。阿伦磷酸钠(一种非雌激素的骨吸收抑制剂)10 mg/d加入该方案中。主要观察指标(S)：子宫内膜异位症病变体积缩小、疼痛缓解、芳香化酶P450信使核糖核酸组织水平、骨密度。结果(S)：阿那曲唑治疗后，循环中17β雌二醇水平降至基线水平的约50%。治疗2个月后疼痛迅速减轻，完全消失。治疗9个月后，30×30×20 mm的大红色息肉状阴道病变缩小为3 mm的灰色组织。在治疗6个月后，从重复活检中获得的标本中，子宫内膜异位症组织中明显高水平的芳香化酶P450信使RNA检测不到。治疗9个月后腰椎骨密度下降6.2%。结论：芳香酶抑制剂在子宫内膜异位症治疗中的应用尚属首次。短期结果非常成功地消除了疼痛，几乎完全根除了与严重子宫内膜异位症相关的植入物，对其他治疗无效。我们的结论是，最近开发的有效的芳香化酶抑制剂是治疗对标准方案耐药的子宫内膜异位症的候选药物。(C)1998年由美国生殖医学学会主办。
Objective: To treat an unusually aggressive case of recurrent postmenopausal endometriosis.Design: Case report.Setting: University of Texas Southwestern Medical Center (Dallas, Texas).Patient(s): A 57-year-old woman who presented with recurrent severe endometriosis after hysterectomy and bilateral salpingo-oophorectomy.Intervention(s): Oral administration of anastrozole (an aromatase inhibitor) (1 mg/d) and elemental calcium (1.5 g/d) for 9 months. Alendronate (a nonestrogenic inhibitor of bone resorption), 10 mg/d, was added to this regimen.Main Outcome Measure(s): Reduction in size of endometriotic lesion, pain relief, tissue levels of aromatase P450 messenger RNA, bone density.Result(s): Circulating levels of estradiol-17 beta were reduced to approximately 50% of the baseline value after the onset of treatment with anastrozole. Pain rapidly decreased and completely disappeared after the 2nd month of treatment. The 30 x 30 x 20-mm bright red polypoid vaginal lesion was reduced to a 3-mm gray tissue by the end of 9 months of treatment. Markedly high pretreatment levels of aromatase P450 messenger RNA in the endometriotic tissue became undetectable in a specimen obtained from a repeated biopsy after 6 months of treatment. Bone density of lumbar spine decreased by 6.2% after 9 months of treatment.Conclusion(s): This is the first description of the use of an aromatase inhibitor in the treatment of endometriosis. The short-term results were extraordinarily successful in elimination of pain and near-complete eradication of implants associated with severe endometriosis not responsive to other therapy. We conclude that the recently developed potent aromatase inhibitors are candidate drugs in the treatment of endometriosis that is resistant to standard regimens. (C) 1998 by American Society for Reproductive Medicine.