Tamoxifen-induced ovarian hyperstimulation during premenopausal hormonal therapy for breast cancer in Japanese women.
Tamoxifen-induced ovarian hyperstimulation during premenopausal hormonal therapy for breast cancer in Japanese women.
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日本女性绝经前乳腺癌激素治疗期间他莫昔芬引起的卵巢过度刺激。
DOI：
10.1186/s40064-015-1223-0
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Fujiwara H
中科院分区：
文献类型：
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作者：
Yamazaki R;Inokuchi M;Ishikawa S;Myojo S;Iwadare J;Bono Y;Mizumoto Y;Nakamura M;Takakura M;Iizuka T;Ohta T;Fujiwara H
他莫昔芬是一种抗雌激素药物，广泛用于内分泌依赖型乳腺癌的激素辅助治疗，据报道，它的使用经常与血清雌二醇水平高有关。由于日本接受他莫昔芬治疗的绝经前妇女的人数正在增加，我们回顾分析了日本妇女接受他莫昔芬治疗的卵巢过度刺激的发生率。11例接受手术治疗的内分泌依赖型乳腺癌患者，在三苯氧胺治疗期间血清雌二醇值升高，通过检测血清卵泡刺激素(FSH)浓度和卵泡发育情况进行评估。平均年龄41.3岁，血清雌二醇、卵泡刺激素浓度分别为1015.8、11.8mIU/m L，卵泡直径3.47m in。6例为多个卵泡发育，另1例为单卵泡发育，平均血清雌二醇水平为848.6 pg/mL，卵泡直径为4.46 cm。两组患者的年龄和FSH浓度均无显著差异。从开始单次服用他莫昔芬到首次检测到高雌二醇浓度的平均时间为716.5天。这些结果表明，他莫昔芬即使在治疗2年后仍能刺激卵巢功能。由于观察到单个和多个大卵泡的发育，可以提出通过抑制下丘脑-垂体轴的负反馈和正反馈的双重机制来解释他莫昔芬对卵巢功能的不利影响。
Tamoxifen is an anti-estrogenic drug that is widely used for endocrine-dependent breast cancer as adjuvant hormonal therapy, and its use has been reported to be frequently associated with high levels of serum estradiol. Since the population of premenopausal women receiving tamoxifen therapy is growing in Japan, we retrospectively analyzed the incidence of ovarian hyperstimulation by tamoxifen therapy in Japanese women. Eleven patients who received surgical therapy for endocrine-dependent breast cancer and showed high values of serum estradiol during post-operative tamoxifen therapy were recruited in this study and evaluated by examining the serum concentration of follicular stimulating hormone (FSH) and follicular development. The mean age, serum concentrations of estradiol and FSH, and follicular diameter were 41.3 years old, 1015.8 pg/mL, 11.8 mIU/mL, and 3.47 cm, respectively. In 6 cases, multiple follicular development was observed, while the other cases showed single follicular development with a mean serum estradiol level of 848.6 pg/mL and follicular diameter of 4.46 cm. There was no significant difference in age or FSH concentration between the two groups. The mean periods from the start of the single administration of tamoxifen to the initial detection of a high estradiol concentration was 716.5 days. These findings indicate that tamoxifen could stimulate the ovarian function even after 2-year treatment. Since single and multiple follicular developments with large sizes were observed, dual mechanisms through the inhibition of both negative and positive feedback to the hypothalamic-pituitary-axis can be proposed to explain the adverse effects of tamoxifen on ovarian function.