Metella Dei

Vulvovaginitis in childhood

Symptoms related to vulvitis and vulvovaginitis are a frequent complaint in the paediatric age. Knowledge of the risk factors and the pathogenetic mechanisms, combined with thorough clinical examination, helps to distinguish between dermatological diseases, non-specific vulvitis and vulvovaginitis proper. On the basis of microbiological data, the most common pathogens prove to be Streptococcus pyogenes, Haemophilus influenzae and Enterobius vermicularis; fungal and viral infections are less frequent. The possibility of isolating opportunistic pathogens should also be considered. In rare situations, the isolation of a micro-organism normally transmitted by sexual contact should prompt a careful evaluation of possible sexual abuse. Current treatments for specific and non-specific forms are outlined, together with pointers for the evaluation of recurrence.

Predictors of recovery of ovarian function after weight gain in subjects with amenorrhea related to restrictive eating disorders.

Objective. The aim of the present study was to investigate the anthropometric and endocrine characteristics of subjects with amenorrhea related to eating disorders after weight recovery, in order to identify factors connected with the resumption of menses. Methods. Clinical data, body composition parameters and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, cortisol, leptin and insulin were assessed in two groups of young women classified according to menstrual status after weight rehabilitation: 43 subjects who displayed persistent amenorrhea and 34 who resumed menses. Univariate and multivariate logistic regression analyses were used to examine the relationships between the different parameters and menstrual recovery. Results. The patients who resumed menses had low initial weight and BMI, and a greater difference between current and initial BMI (ΔBMI), than those with amenorrhea. No differences were observed in lean mass, body fat or bone density between the two groups. Moreover, the reduction in FSH and the increase in LH, insulin and leptin emerged as significant predictors of menstrual recovery. Increased ΔBMI and insulin continued to be positive predictors in the multivariate analysis. Conclusion. Following weight rehabilitation, the individuals metabolic set point before weight loss and the current insulin levels appear significant in predicting the reactivation of reproductive function.

Hepatotoxicity with low- and ultralow-dose flutamide: a surveillance study on 203 hyperandrogenic young females

OBJECTIVE To investigate the impact of low- and ultralow-dose regimens of flutamide on liver function of young hyperandrogenic females. DESIGN A 10-year surveillance study. SETTING University teaching hospital. PATIENT(S) Two hundred three hyperandrogenic young females (mean age: 20.9 ± 4.9 years). INTERVENTION(S) Inclusion criterion was receiving low- or ultralow-dose of flutamide as antiandrogenic treatment. Patients were categorized into Groups A and B, according to the administered dose (Group A = 62.5 mg/daily, Group B = 125 mg/daily). The two groups were further subdivided into subgroups (A1, A2, B1, B2) depending on the coadministration of estroprogestagen oral contraceptives (OCs) (A2, B2). MAIN OUTCOME MEASURE(S) Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were periodically evaluated and used as markers of hepatotoxicity. RESULT(S) Mild-to-severe increase of circulating AST/ALT was detected in 19 (9.4%; 95% CI = 5.9%-14.4%) patients during the first year of treatment (mild = 16 [7.9%, 95% CI = 4.7%-12.7%], moderate = 2 [0.9%, 95% CI = 0.1%-3.9%], severe = 1 [0.5%, 95% CI = 0.0%-3.1%]). No statistical differences were observed in relation to flutamide dose regimens and coadministration of OC. The median time to hypertransaminasemia was 12 weeks (range: 2-48) with no difference between Group A and Group B. A significant correlation was observed between hepatotoxicity and pretreatment BMI, ALT basal level, and AST basal level. CONCLUSION(S) Hepatotoxicity is a rare but possible event using low- and ultralow-dose regimens of flutamide. We need larger study populations in order to identify risk patterns for hepatotoxicity development.

The Management of Polycystic Ovary Syndrome

Abstract: It is well known that subjects with polycystic ovary syndrome (PCOS) show very variable clinical and biochemical aspects. Considering long‐term repercussions, two main disturbances, not always strictly related, need to be countered: hyperandrogenism and insulin resistance, with compensatory hyperinsulinemia. The aim of this review is to summarize therapeutic perspectives for PCOS, starting from basic approach, such as weight reduction and changes in lifestyle. The benefits of long‐term use of oral contrceptives and the criteria of choice of the estro‐progestin combinations are discussed. With severe hyperandogenism, a pure antiandrogen should be added. The experiences with insulin‐sensitizing drugs, especially metformin, are reviewed; while their beneficial role as an adjuvant to treatment of ovulatory infertility has been well established, the effects of a long‐term treatment, especially in very young patients, are still under debate. Current studies are testing the results of combinations of different treatments at low dosage; randomized comparative trials on the long‐term efficacy of these approaches have yet to be scheduled.

Estrogen Replacement Therapy in the Management of Osteopenia Related to Eating Disorders

Abstract: The effect of hormone replacement therapy on the bone mineral content of hypoestrogenic subjects depends on the pathogenesis of the disease as well as on the dosage and route of administration. This is particularly true in hypoestrogenism related to eating disorders. We present a longitudinal study of 26 young women with diet‐induced amenorrhea compared with a group of subjects with POF. The study protocol included the quantification of weight loss, the endocrine profile (follicle‐stimulating hormone, luteinizing hormone, prolactin, E2, FT3, FT4, thyroid‐stimulating hormone, and cortisol), the evaluation of markers of bone turnover (GLA, OSTK‐PR, ALP, OHP, and DPYR), and spinal bone density by DEXA at observation and after weight recovery. No hormone replacement therapy was administered. Mean BMD and Z scores before and after recovery do not differ significantly; OHP and DPYR appear significantly higher during basal evaluation, whereas GLA and ALP do not. Data on the impact of oral contraceptive use on bone mineral density are controversial. We particularly discuss the question of long‐term treatment with 20 μg ethinyl estradiol pills on peak bone mass acquisition during adolescence.

Sex steroids and libido

The effects of steroidal hormones on sexual desire and motivation are a question still under debate. This paper reviews up-to-date knowledge regarding physiological imprinting and activation by endogenous hormones of central nervous system areas involved in libido during intrauterine life and puberty. The endocrine environment probably continues to play a role during fertile life and the postmenopausal period, but this effect is often overridden by psychological and social factors. The impairment of sexual interest during estrogen-progestin treatment is an infrequent but relevant side-effect whose possible underlying mechanisms are discussed. Both endocrine and psychorelational elements may interact. From the biological point of view, androgen and oxytocin level modification and loss of estrogen fluctuations have been considered, but also the history of hormone-related mood changes could be a risk factor. On the psychological side, both the profound repercussions of the contraceptive choice and consequent responsibility, as well as the high value attributed to sexual experience are probably facilitating elements in the loss of libido under treatment.

Hemangioma of the Clitoris Presenting as Clitoromegaly: A Case Report

A 20-year-old woman with massive clitoral enlargement is presented to discuss the differential diagnosis and the treatment of this condition.

Body composition variables and leptin levels in functional hypothalamic amenorrhea and amenorrhea related to eating disorders.

The purpose of the study was to identify diagnostic criteria that can distinguish between subjects with functional hypothalamic amenorrhea largely related to minimal energy deficiency and those in whom failure of adaptive response to stress prevails. We studied 59 young women with secondary amenorrhea related to modest eating disorders and 58 who complained of stressful events in their history. We assessed anthropometric measurements, body composition using dual energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), and basal endocrine profile. Subjects with disordered eating had lower body mass index (BMI), fat mass (FM) measured with both techniques, lumbar mineral density and direct and indirect measures of lean mass. Leptin and free tri-iodothyronine(FT(3)) concentrations also proved lower in the group of subjects with eating disorders, although there was no significant difference in cortisol between the two groups. Leptin levels were positively associated not only with fat mass, but also with body cell mass indexed to height and phase angle, parameters studied with BIA as expression of active lean compartment. A multivariate model confirmed the utility of integrating endocrine data with the study of body composition. The use of bioelectrical impedance analysis proved to be, in clinical use, a valid diagnostic alternative to DEXA, especially considering body cell mass and phase angle.

The resistance to contraceptive use in young Italian women

Objective To investigate the personal relationship and social factors that influence young women not to use contraceptives. Methods A total of 104 young women aged 14-23 years were studied using a 26-item questionnaire which was to be filled out individually. The questionnaire addressed use of contraceptives at the first intercourse and current use, together with various items related to age, educational level, self-image, fantasy about parenthood, and characteristics of the relationships with the partner and the family. A descriptive analysis and a multivariate logistic regression model investigated the relationship between contraceptive non-use and selected variables. Results Twenty-four percent of the girls did not use any effective contraceptive method at the first sexual intercourse and 21% were current non-users. The study of characteristics associated with inconsistent contraceptive use shows a complex picture where young age, poor knowledge of the partner, an older partner and living in a incomplete family nucleus or outside the family represent significant risk factors. Considering our results as a whole, contraceptive non-use is not only a marker of risk-taking behavior, but sometimes expresses irrational feelings which emerge when facing new sexual experience.

Polycystic ovary syndrome in adolescence

The definition of polycystic ovary syndrome in very young girls is complicated by the fact that many features typical of the syndrome can also be seen as physiological stages in the maturation of the hypothalamus–pituitary–ovarian axis. The role of reduced insulin sensitivity in the pathogenesis and evolution of the disorder has gained more importance over recent years: both elevated androgen levels and being overweight may influence the impairment of glucose metabolism. Our study focused on 250 girls in the first 8 years of gynecological age. We analyzed the prevalence of different phenotypes according to the Rotterdam criteria and the impact of higher BMI on androgen levels and on fasting screening markers of glucose metabolism. In a smaller sample, we performed a more detailed evaluation of the glucose metabolism parameters; our findings indicated that in this age group, being overweight plays a major role in the deterioration of the clinical picture.