Yasuaki Yamamoto

Effect of troglitazone on endocrine and ovulatory performance in women with insulin resistance-related polycystic ovary syndrome

OBJECTIVE To investigate the effect of troglitazone, a new antidiabetic agent that improves insulin resistance, on endocrine, metabolic, and ovulatory performance in women with insulin resistance-related polycystic ovary syndrome (PCOS). DESIGN Prospective clinical study. SETTING Infertility outpatient clinic, Niigata University Hospital, Niigata, Japan. PATIENT(S) Thirteen women with PCOS and insulin resistance. INTERVENTION(S) Troglitazone (400 mg/d) was administered for 12 weeks. MAIN OUTCOME MEASURE(S) Insulin and other hormone (gonadotropins, androgens) levels; various parameters relating to glucose and lipid metabolism before, during, and after troglitazone administration; and ovulation rate. RESULT(S) The mean (+/-SD) fasting insulin concentration was significantly reduced, from 18.3+/-8.9 to 10.5+/-7.1 microU/mL. The LH level was reduced from 9.7+/-3.4 to 4.8+/-3.9 mIU/mL and the testosterone level was reduced from 0.9+/-0.5 to 0.5+/-0.3 ng/mL in accordance. Atherosclerotic lipid levels also were normalized. Before troglitazone administration, the ovulation rate during clomiphene citrate therapy was 34.9% per cycle (15/43). This increased significantly to 72.7% (8/11) during troglitazone coadministration. Further, an ovulation rate of 42.3% (11/26) was achieved with troglitazone alone. CONCLUSION(S) In women with PCOS and insulin resistance, the reduction of hyperinsulinemia that is produced by troglitazone improves the hyperandrogenism that characterizes PCOS, restoring ovulation.

Bone structural and metabolic changes at the end of pregnancy and lactation in rats.

OBJECTIVE The objective of this study was to elucidate the net change of bone structure and metabolism in the lumbar trabecular bone of rats at the end of the pregnancy and lactation. STUDY DESIGN Female virgin Sprague-Dawley rats aged 200 days were mated, and bone mineral density by dual-energy x-ray absorptiometry, bone histomorphometry, and serum bone metabolic markers were measured at the end of pregnancy (day 22 of pregnancy), after delivery (day 5 post partum), and at the end of lactation (day 21 post partum). RESULTS At the end of pregnancy bone mineral density, bone volume, trabecular thickness, and serum calcium decreased; serum parathyroid hormone increased; and the histomorphometric parameters indicated that bone resorption were higher than those variables in nonpregnant rats, but bone formation was suppressed, as demonstrated by the low histomorphometric parameters and by the low serum alkaline phosphatase levels. After delivery the bone mineral density of nonlactating rats recovered rapidly, as in nonpregnant rats, but nonlactating rats showed more bone formation by histomorphometry than nonpregnant rats did. At the end of lactation, bone mineral density and serum calcium levels decreased considerably, and lactating rats showed substantial bone formation, bone resorption, and high serum alkaline phosphatase levels. The correlation between the number of pups (x) of the lactating and nonlactating groups and the bone mineral density (y, in grams per square centimeter) showed simple linear regression (y = -0.0067 . x +0.2517, r = 0.949, p < 0.0001). CONCLUSIONS These results indicate that significant decreases occur in the trabecular bone of rats at the end of pregnancy and lactation and that lactational intensity is related to bone mineral density.

Elevated serum CA125 and CA19-9 due to the spontaneous rupture of ovarian endometrioma

A 23-year-old woman was suffered from ruptured ovarian endometrioma with an elevated CA125 and CA19-9 concentration; 9537 and 15,653IU/ml, respectively. Rapid decrease in serum CA125 and CA19-9 was recognized before surgery. Such high levels of both antigens have not been reported in a patient with endometriosis.

Disseminated Intravascular Coagulation Associated with Intratumoral Hemorrhage of Ovarian Cancer

Background: Ovarian carcinoma usually presents in an indolent manner. A patient with ovarian cancer rarely shows acute clinical features which require immediate medical intervention. Case: We present a 36-year-old Japanese woman with an ovarian tumor, who suffered general fatigue and increased abdominal girth on admission. Her hemoglobin, platelet count and fibrinogen were decreased, and fibrin/fibrinogen degradation products were elevated, which determined the diagnosis of disseminated intravascular coagulation (DIC). Since computed tomography scan and magnetic resonance imaging revealed an intratumoral hemorrhage, an emergency laparotomy was performed. The patient was found to have ovarian cancer with a massive intratumoral hemorrhage, and DIC improved immediately after the operation. Conclusion: The clinician should be alert to the possibility that intratumoral bleeding of ovarian cancer might be associated with DIC.

Effect of hormone replacement therapy on bone and lipid metabolism in women oophorectomized for the treatment of gynecologic malignancies.

Objective: Our purpose was to evaluate the effects of hormone replacement therapy (HRT) on bone and lipid metabolism in women oophorectomized for the treatment of gynecologic malignancies. Methods: Bone mineral density (BMD), bone metabolic markers, sex hormones and lipoproteins were measured in three groups of age‐ and body mass‐matched subjects. The subjects consisted of HRT(+) patients, i.e. those given HRT after oophorectomy (n = 39), HRT(−) patients, who received no HRT (n = 15), and controls comprising premenopausal women with no history of oophorectomy (n = 36). Results: BMD decreased significantly in the HRT(−) patients, but no decrease in BMD was observed in the controls or HRT(+) patients. HRT was effective in preventing bone loss by reducing high‐turnover osteopenia. HRT reversed the negative trends in lipoprotein profiles by lowering low‐density lipoprotein cholesterol and increasing high‐density lipoprotein cholesterol. There were no serious side effects or recurrences among the HRT(+) patients. Conclusion: HRT appeared to have beneficial effects on bone and lipid metabolism in oophorectomized patients treated for gynecologic malignancies.