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[PMID]:27693265
[Au] Autor:Fung R; Hellstern-Layefsky M; Tastenhoye C; Lega I; Steele L
[Ad] Endereço:Michael Garron Hospital, Toronto East Health Network, Toronto, ON, Canada. Electronic address: rfung@tegh.on.ca.
[Ti] Título:Differential Effects of Cyproterone Acetate vs Spironolactone on Serum High-Density Lipoprotein and Prolactin Concentrations in the Hormonal Treatment of Transgender Women.
[So] Source:J Sex Med;13(11):1765-1772, 2016 Nov.
[Is] ISSN:1743-6109
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Spironolactone and cyproterone acetate (CPA) are the two main antiandrogen medications used in feminizing hormone therapy in transgender women. Previous studies have suggested that these two agents might have opposite effects on high-density lipoprotein (HDL) level when used in this context, and limited data have suggested CPA increases prolactin more than spironolactone. AIM: To compare the effects of spironolactone and CPA on HDL and prolactin serum concentrations in transgender women. METHODS: A retrospective chart review was conducted at three clinical sites in Toronto, Ontario, Canada. Patients were selected if they (i) identified as a transgender woman, (ii) had newly started spironolactone or CPA with estrogen or restarted spironolactone or CPA after a washout period of at least 6 months, and (iii) had not used other antiandrogens within the previous 6 months. MAIN OUTCOME MEASURES: HDL and prolactin concentrations between the two treatment groups at baseline and at 12 months. RESULTS: Eighty-two patients were included in the spironolactone group and 31 patients were included in the CPA group. Baseline HDL and prolactin levels were not significantly different between the two groups. At 12 months, HDL increased by 0.10 mmol/L (SD = 0.24) in the spironolactone group but decreased by 0.07 mmol/L (SD = 0.21) in the CPA group (P = .002). The difference remained significant after adjusting for baseline HDL, use of lipid-lowering drugs, and age. The change in prolactin was +3.10 µg/L (SD = 5.70) in the spironolactone group and +11.8 µg/L (SD = 8.63) in the CPA group (P < 0.001). This difference also remained significant after adjusting for baseline prolactin level. CONCLUSION: These data suggest that spironolactone use in transgender women increases HDL levels and that CPA has the opposite effect. CPA also is associated with a larger increase in prolactin. These factors should be considered when choosing between these two antiandrogen agents.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Acetato de Ciproterona/uso terapêutico
Lipoproteínas HDL/efeitos dos fármacos
Prolactina/efeitos dos fármacos
Espironolactona/uso terapêutico
Transexualismo/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Canadá
Ciproterona/uso terapêutico
Quimioterapia Combinada
Estrogênios/uso terapêutico
Feminino
Seres Humanos
Lipoproteínas HDL/metabolismo
Masculino
Prolactina/metabolismo
Estudos Retrospectivos
Cirurgia de Readequação Sexual/métodos
Pessoas Transgênero
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Estrogens); 0 (Lipoproteins, HDL); 27O7W4T232 (Spironolactone); 4KM2BN5JHF (Cyproterone Acetate); 9002-62-4 (Prolactin); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170612
[Lr] Data última revisão:
170612
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161004
[St] Status:MEDLINE


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[PMID]:27590388
[Au] Autor:Chen CH; Chin HY; Chen HH; Chang HY; Liu WM
[Ad] Endereço:Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
[Ti] Título:Pills-related severe adverse events: A case report in Taiwan.
[So] Source:Taiwan J Obstet Gynecol;55(4):588-90, 2016 Aug.
[Is] ISSN:1875-6263
[Cp] País de publicação:China (Republic : 1949- )
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To review and evaluate the potential adverse effects of these oral contraceptives (OCP) to overweight women. CASE REPORT: A 19-year-old college student, with a body mass index (BMI) of 35.2 kg/m(2), who received 2 months of OCP containing cyproterone and ethinyl estradiol for polycystic ovary syndrome (PCOS)-related menstrual problems was complicated with a thromboembolism-related life-threatened disease. After intensive care, including the use of an extracorporeal membrane oxygenation system, thrombolytic treatment, anticoagulant, and inferior vena filter, she recovered well without significant sequelae. CONCLUSION: This case illustrates the risk of using OCPs, especially for those containing cyproterone and ethinyl estradiol components, as a treatment for menstrual problems in young women with PCOS and a high BMI.
[Mh] Termos MeSH primário: Anticoncepcionais Orais Combinados/efeitos adversos
Ciproterona/efeitos adversos
Etinilestradiol/efeitos adversos
Distúrbios Menstruais/tratamento farmacológico
Tromboembolia/induzido quimicamente
[Mh] Termos MeSH secundário: Antagonistas de Androgênios/efeitos adversos
Índice de Massa Corporal
Estrogênios/efeitos adversos
Feminino
Seres Humanos
Distúrbios Menstruais/etiologia
Sobrepeso/complicações
Síndrome do Ovário Policístico/complicações
Taiwan
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Contraceptives, Oral, Combined); 0 (Estrogens); 423D2T571U (Ethinyl Estradiol); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170426
[Lr] Data última revisão:
170426
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160904
[St] Status:MEDLINE


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[PMID]:26249273
[Au] Autor:Botella C; Coll G; Lemaire JJ; Irthum B
[Ad] Endereço:Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France. Electronic address: celine-bc@hotmail.fr.
[Ti] Título:[Intra cranial meningiomas and long term use of cyproterone acetate with a conventional dose in women. A report of two cases of tumor decrease after treatment withdrawal].
[Ti] Título:Méningiomes intracrâniens et utilisation prolongée d'acétate de cyprotérone à dose conventionnelle chez la femme: à propos de deux cas de régression tumorale après arrêt du traitement..
[So] Source:Neurochirurgie;61(5):339-42, 2015 Oct.
[Is] ISSN:1773-0619
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:The action of synthetic progestogens, prescribed at a conventional dose in women, for a meningioma, is still poorly understood, and could be related to progesterone receptors. We report two cases illustrating multiple meningiomas with stabilization or tumor reduction after withdrawal of cyproterone acetate originally prescribed for a long term period. We also review the influence of synthetic progestogens on meningiomas, particularly the impact of treatment withdrawal.
[Mh] Termos MeSH primário: Acetato de Ciproterona/farmacologia
Ciproterona/farmacologia
Neoplasias Meníngeas/tratamento farmacológico
Meningioma/tratamento farmacológico
Suspensão de Tratamento
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Neoplasias Meníngeas/patologia
Meningioma/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; ENGLISH ABSTRACT; JOURNAL ARTICLE
[Nm] Nome de substância:
4KM2BN5JHF (Cyproterone Acetate); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1608
[Cu] Atualização por classe:151013
[Lr] Data última revisão:
151013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150808
[St] Status:MEDLINE


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[PMID]:25162092
[Ti] Título:Ethinylestradiol + cyproterone: back in France for acne and hirsutism, despite frequent off-label prescription.
[So] Source:Prescrire Int;23(151):183, 2014 Jul.
[Is] ISSN:1167-7422
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Following a European review, products containing the ethinylestradiol + cyproterone combination are back on the French market for women with acne (as second-line treatment) or hirsutism. Yet experience has shown that frequent off-label prescription of this combination for contraceptive purposes exposes many women to an unjustified risk of thromboembolism.
[Mh] Termos MeSH primário: Acne Vulgar/tratamento farmacológico
Ciproterona/efeitos adversos
Etinilestradiol/efeitos adversos
Hirsutismo/tratamento farmacológico
Uso Off-Label
[Mh] Termos MeSH secundário: Ciproterona/administração & dosagem
Etinilestradiol/administração & dosagem
Seres Humanos
Tromboembolia/induzido quimicamente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
423D2T571U (Ethinyl Estradiol); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1409
[Cu] Atualização por classe:140827
[Lr] Data última revisão:
140827
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:140828
[St] Status:MEDLINE


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[PMID]:24590565
[Au] Autor:de Bastos M; Stegeman BH; Rosendaal FR; Van Hylckama Vlieg A; Helmerhorst FM; Stijnen T; Dekkers OM
[Ad] Endereço:Instituto Previdencia dos Servidores do Estado de Minas Gerais, Minas Gerais, Brazil.
[Ti] Título:Combined oral contraceptives: venous thrombosis.
[So] Source:Cochrane Database Syst Rev;(3):CD010813, 2014 Mar 03.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available. OBJECTIVES: To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. SEARCH METHODS: Electronic databases (Pubmed, Embase, Web of Science, Cochrane, CINAHL, Academic Search Premier and ScienceDirect) were searched in 22 April 2013 for eligible studies, without language restrictions. SELECTION CRITERIA: We selected studies including healthy women taking COC with VT as outcome. DATA COLLECTION AND ANALYSIS: The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported.Two independent reviewers extracted data from selected studies. MAIN RESULTS: 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 0.19 and 0.37 per 1 000 person years, in line with previously reported incidences of 0,16 per 1 000 person years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. AUTHORS' CONCLUSIONS: All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol. Risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate and drospirenone were similar, and about 50-80% higher than with levonorgestrel. The combined oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed-that is, 30 µg ethinylestradiol with levonorgestrel.
[Mh] Termos MeSH primário: Anticoncepcionais Orais Combinados/efeitos adversos
Embolia Pulmonar/induzido quimicamente
Trombose Venosa/induzido quimicamente
[Mh] Termos MeSH secundário: Androstenos/efeitos adversos
Ciproterona/efeitos adversos
Desogestrel/efeitos adversos
Etinilestradiol/efeitos adversos
Feminino
Seres Humanos
Levanogestrel/efeitos adversos
Norpregnenos/efeitos adversos
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Androstenes); 0 (Contraceptives, Oral, Combined); 0 (Norpregnenes); 1664P6E6MI (Gestodene); 423D2T571U (Ethinyl Estradiol); 5W7SIA7YZW (Levonorgestrel); 81K9V7M3A3 (Desogestrel); E61Q31EK2F (Cyproterone); N295J34A25 (drospirenone)
[Em] Mês de entrada:1409
[Cu] Atualização por classe:160602
[Lr] Data última revisão:
160602
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140305
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010813.pub2


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Registro de Ensaios Clínicos
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[PMID]:24554512
[Au] Autor:Dardzinska JA; Rachon D; Kuligowska-Jakubowska M; Aleksandrowicz-Wrona E; Ploszynski A; Wyrzykowski B; Lysiak-Szydlowska W
[Ad] Endereço:Department of Clinical Nutrition, Medical University of Gdansk, Gdansk, Poland.
[Ti] Título:Effects of metformin or an oral contraceptive containing cyproterone acetate on serum c-reactive protein, interleukin-6 and soluble vascular cell adhesion molecule-1 concentrations in women with polycystic ovary syndrome.
[So] Source:Exp Clin Endocrinol Diabetes;122(2):118-25, 2014 Feb.
[Is] ISSN:1439-3646
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The aim of the present study was to evaluate the effects of commonly used treatment regimens such as metformin (MET) or an oral contraceptive pill (OC) containing ethynyloestradiol and cyproterone acetate (EE-CPA) on surrogate serum CVD risk factors and markers of endothelial dysfunction (CRP, IL-6, sVCAM) in women with PCOS.This study was conducted in a crossover design in order to compare the effects of 2 different treatment regimens in the same subject and has been registered under the number NCT01798875 in the ClinicalTrials.gov registry.42 women with PCOS (age range 18-36 years, median BMI 24.9) were randomly assigned to treatment with MET (850 mg bid) or EE-CPA containing OC for 4 months. After 2 months washout period, treatments were crossed over.Treatment with and OC increased significantly serum CRP concentrations (from 0.77 mg/l [95% CI: 0.70; 2.18] to 1.70 mg/l [95% CI: 1.65; 3.69], P<0.001). Treatment with MET slightly reduced serum CRP levels, but this difference did not reach statistical significance (P=0.08). 4 months treatment with MET or EE-CPA had no effect on serum IL-6 and sVCAM-1 concentrations (P>0.05).Treatment with EE-CPA containing OC for 4 months in women with PCOS significantly raises serum CRP. Since this rise was not accompanied by the increase in serum concentrations of IL-6, which is the most potent and effective stimulant of hepatic CRP production, we can speculate that this effect is caused by the liver first-pass effect of oral oestrogen administration. If this in turn can confer, cardiovascular risk among these women warrants further -studies.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/administração & dosagem
Proteína C-Reativa/metabolismo
Anticoncepcionais Orais/administração & dosagem
Ciproterona/administração & dosagem
Hipoglicemiantes/administração & dosagem
Interleucina-6/sangue
Metformina/administração & dosagem
Síndrome do Ovário Policístico
Molécula 1 de Adesão de Célula Vascular/sangue
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos Transversais
Feminino
Seguimentos
Seres Humanos
Síndrome do Ovário Policístico/sangue
Síndrome do Ovário Policístico/tratamento farmacológico
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Contraceptives, Oral); 0 (Hypoglycemic Agents); 0 (IL6 protein, human); 0 (Interleukin-6); 0 (Vascular Cell Adhesion Molecule-1); 9007-41-4 (C-Reactive Protein); 9100L32L2N (Metformin); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1410
[Cu] Atualização por classe:160701
[Lr] Data última revisão:
160701
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140221
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1055/s-0033-1363261


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[PMID]:24034759
[Au] Autor:Cucalón JM; Guiu M
[Ad] Endereço:Medicina de Familia y Comunitaria, Centro de Salud Híjar, Servicio Aragonés de Salud, Teruel, España. Electronic address: jcucalona@semg.es.
[Ti] Título:[The enigma of quaternary prevention in Primary Care. When and when not to do it (presentation of two cases)].
[Ti] Título:El enigma de la prevención cuaternaria en atención primaria. Cuándo hacer y cuándo no hacer (a propósito de 2 casos)..
[So] Source:Semergen;39(6):313-5, 2013 Sep.
[Is] ISSN:1578-8865
[Cp] País de publicação:Spain
[La] Idioma:spa
[Ab] Resumo:Quaternary prevention has been commonly defined with the "primum non nocere" of classical texts by many authors. The daily life of our primary care consultations are full of patients in which we wondered if we try to obtain the benefit of our intervention will exceed the damage we cause him to intervene. Patients with multiple comorbidities, polypharmacy and complex are common in our consultations and it is becoming more difficult to move the balance of our actions, diagnostic or therapeutic benefit to the side. Through 2 cases often move to the reflection of this problem. Quaternary prevention must also be present in our daily activities.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/efeitos adversos
Anilidas/efeitos adversos
Conservadores da Densidade Óssea/efeitos adversos
Ciproterona/efeitos adversos
Prescrição Inadequada/prevenção & controle
Indóis/efeitos adversos
Nitrilos/efeitos adversos
Osteoporose/tratamento farmacológico
Atenção Primária à Saúde
Neoplasias da Próstata/tratamento farmacológico
Compostos de Tosil/efeitos adversos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; ENGLISH ABSTRACT; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Anilides); 0 (Bone Density Conservation Agents); 0 (Indoles); 0 (Nitriles); 0 (Tosyl Compounds); A0Z3NAU9DP (bicalutamide); E61Q31EK2F (Cyproterone); Q16TT9C5BK (bazedoxifene)
[Em] Mês de entrada:1511
[Cu] Atualização por classe:161021
[Lr] Data última revisão:
161021
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130917
[St] Status:MEDLINE


  8 / 1663 MEDLINE  
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[PMID]:23866351
[Ti] Título:Ethinylestradiol + cyproterone. Good riddance.
[So] Source:Prescrire Int;22(139):151, 2013 Jun.
[Is] ISSN:1167-7422
[Cp] País de publicação:France
[La] Idioma:eng
[Mh] Termos MeSH primário: Acne Vulgar/tratamento farmacológico
Ciproterona/efeitos adversos
Etinilestradiol/efeitos adversos
[Mh] Termos MeSH secundário: Ciproterona/administração & dosagem
Combinação de Medicamentos
Etinilestradiol/administração & dosagem
Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drug Combinations); 423D2T571U (Ethinyl Estradiol); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1308
[Cu] Atualização por classe:131121
[Lr] Data última revisão:
131121
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:130720
[St] Status:MEDLINE


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[PMID]:23574768
[Au] Autor:Colizzi M; Costa R; Pace V; Todarello O
[Ad] Endereço:Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy.
[Ti] Título:Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style.
[So] Source:J Sex Med;10(12):3049-58, 2013 Dec.
[Is] ISSN:1743-6109
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Gender identity disorder may be a stressful situation. Hormonal treatment seemed to improve the general health as it reduces psychological and social distress. The attachment style seemed to regulate distress in insecure individuals as they are more exposed to hypothalamic-pituitary-adrenal system dysregulation and subjective stress. AIM: The objectives of the study were to evaluate the presence of psychobiological distress and insecure attachment in transsexuals and to study their stress levels with reference to the hormonal treatment and the attachment pattern. METHODS: We investigated 70 transsexual patients. We measured the cortisol levels and the perceived stress before starting the hormonal therapy and after about 12 months. We studied the representation of attachment in transsexuals by a backward investigation in the relations between them and their caregivers. MAIN OUTCOME MEASURES: We used blood samples for assessing cortisol awakening response (CAR); we used the Perceived Stress Scale for evaluating self-reported perceived stress and the Adult Attachment Interview to determine attachment styles. RESULTS: At enrollment, transsexuals reported elevated CAR; their values were out of normal. They expressed higher perceived stress and more attachment insecurity, with respect to normative sample data. When treated with hormone therapy, transsexuals reported significantly lower CAR (P < 0.001), falling within the normal range for cortisol levels. Treated transsexuals showed also lower perceived stress (P < 0.001), with levels similar to normative samples. The insecure attachment styles were associated with higher CAR and perceived stress in untreated transsexuals (P < 0.01). Treated transsexuals did not expressed significant differences in CAR and perceived stress by attachment. CONCLUSION: Our results suggested that untreated patients suffer from a higher degree of stress and that attachment insecurity negatively impacts the stress management. Initiating the hormonal treatment seemed to have a positive effect in reducing stress levels, whatever the attachment style may be.
[Mh] Termos MeSH primário: Ansiedade/tratamento farmacológico
Ansiedade/etiologia
Identidade de Gênero
Hormônios/uso terapêutico
Estresse Psicológico/tratamento farmacológico
Estresse Psicológico/etiologia
Pessoas Transgênero/psicologia
Transexualismo/complicações
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antagonistas de Androgênios/uso terapêutico
Androgênios/uso terapêutico
Ciproterona/uso terapêutico
Estradiol/uso terapêutico
Feminino
Seres Humanos
Hidrocortisona/sangue
Masculino
Meia-Idade
Testosterona/uso terapêutico
Transexualismo/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Androgens); 0 (Hormones); 3XMK78S47O (Testosterone); 4TI98Z838E (Estradiol); E61Q31EK2F (Cyproterone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1407
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130412
[St] Status:MEDLINE
[do] DOI:10.1111/jsm.12155


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[PMID]:23444510
[Ti] Título:First-line treatment of metastatic prostate cancer. Androgen suppression for symptomatic disease.
[So] Source:Prescrire Int;22(135):48-51, 2013 Feb.
[Is] ISSN:1167-7422
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Prostate cancer sometimes metastasizes, especially to bone, which may cause pain, fractures and spinal cord compression. What are the best first-line treatment options for patients with metastatic prostate cancer? To answer this question, we conducted a review of the literature, using the standard Prescrire methodology. Suppressing androgen secretion by surgically removing the testicles (orchiectomy) or by administering a gonadorelin agonist relieves the pain associated with bone metastases in about 80% of patients. This treatment has a clear impact on symptoms, despite the lack of clinical trials versus placebo or no treatment. Its impact on overall survival is uncertain. In terms of survival, goserelin therapy appears to have similar efficacy to orchiectomy. The efficacy of other gonadorelin agonists is less well documented. Degarelix, a gonadorelin antagonist, does not appear to provide a therapeutic advantage over gonadorelin agonist. In 2012, oestrogen should not be used in the treatment of metastatic prostate cancer, because of its cardiovascular adverse effects. Antiandrogen monotherapy, preferably with flutamide, appears to be less beneficial than orchiectomy in terms of survival. Overall, adverse effects are more frequent with nonsteroidal antiandrogens than with gonadorelin agonists, but sexual dysfunction is less frequent. Cyproterone, a steroidal antiandrogen, seems to have fewer adverse effects leading to treatment discontinuation than nonsteroidal antiandrogens. There is no firm evidence that starting hormonal therapy before metastases become symptomatic is beneficial. When symptoms have disappeared and the PSA level is low, one option is to temporarily interrupt gonadorelin agonist therapy if it is poorly tolerated, even though this may shorten survival by a few months. The addition of a nonsteroidal antiandrogen to androgen suppression therapy slightly improves 5-year survival, preventing about 3 deaths per 100 patients, but at a cost of additional adverse effects. First-line hormonal treatments are initially very effective in relieving symptoms of metastatic prostate cancer. Our analysis of the available data suggests that the best treatment option is androgen suppression with goserelin. Flutamide monotherapy is an alternative for some patients.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Antineoplásicos Hormonais/uso terapêutico
Neoplasias Ósseas/terapia
Neoplasias Hormônio-Dependentes/terapia
Orquiectomia
Neoplasias da Próstata/terapia
[Mh] Termos MeSH secundário: Antagonistas de Androgênios/efeitos adversos
Antineoplásicos Hormonais/efeitos adversos
Neoplasias Ósseas/metabolismo
Neoplasias Ósseas/mortalidade
Neoplasias Ósseas/secundário
Ciproterona/uso terapêutico
Estrogênios/uso terapêutico
Flutamida/uso terapêutico
Gosserrelina/uso terapêutico
Seres Humanos
Masculino
Neoplasias Hormônio-Dependentes/metabolismo
Neoplasias Hormônio-Dependentes/mortalidade
Neoplasias Hormônio-Dependentes/patologia
Orquiectomia/efeitos adversos
Orquiectomia/mortalidade
Guias de Prática Clínica como Assunto
Neoplasias da Próstata/metabolismo
Neoplasias da Próstata/mortalidade
Neoplasias da Próstata/patologia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Androgen Antagonists); 0 (Antineoplastic Agents, Hormonal); 0 (Estrogens); 0F65R8P09N (Goserelin); 76W6J0943E (Flutamide); E61Q31EK2F (Cyproterone)
[Em] Mês de entrada:1303
[Cu] Atualização por classe:131121
[Lr] Data última revisão:
131121
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:130228
[St] Status:MEDLINE



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