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Tamoxifen-induced ovarian hyperstimulation during premenopausal hormonal therapy for breast cancer in Japanese women.

Yamazaki R, Inokuchi M, Ishikawa S, Myojo S, Iwadare J, Bono Y, Mizumoto Y, Nakamura M, Takakura M, Iizuka T, Ohta T, Fujiwara H - Springerplus (2015)

Bottom Line: There was no significant difference in age or FSH concentration between the two groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8641 Japan.

ABSTRACT

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus

Inhibitory action of TAM on positive feedback to the hypothalamic-pituitary-axis by estrogen during the ovulatory phase. TAM can inhibit positive feedback to the hypothalamic-pituitary-axis by estrogen, leading to inhibition of the LH surge and then inducing the formation of a large follicular functional cyst
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Fig2: Inhibitory action of TAM on positive feedback to the hypothalamic-pituitary-axis by estrogen during the ovulatory phase. TAM can inhibit positive feedback to the hypothalamic-pituitary-axis by estrogen, leading to inhibition of the LH surge and then inducing the formation of a large follicular functional cyst

Mentions: Theoretically, the anti-estrogenic effects on the hypothalamic-pituitary-axis also interfere with positive feedback, leading to inhibition of the LH surge (Fig. 2). Once the LH surge occurs, granulosa cells in the mature follicles will undergo luteinization, in which the steroid hormone production shifts from estradiol to progesterone (Devoto et al. 2002). Therefore, the formation of the single functional follicular cyst that produced estradiol at more than 500 pg/mL in the serum, strongly suggests the absence of the LH surge.Fig. 2


Tamoxifen-induced ovarian hyperstimulation during premenopausal hormonal therapy for breast cancer in Japanese women.

Yamazaki R, Inokuchi M, Ishikawa S, Myojo S, Iwadare J, Bono Y, Mizumoto Y, Nakamura M, Takakura M, Iizuka T, Ohta T, Fujiwara H - Springerplus (2015)

Inhibitory action of TAM on positive feedback to the hypothalamic-pituitary-axis by estrogen during the ovulatory phase. TAM can inhibit positive feedback to the hypothalamic-pituitary-axis by estrogen, leading to inhibition of the LH surge and then inducing the formation of a large follicular functional cyst
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539309&req=5

Fig2: Inhibitory action of TAM on positive feedback to the hypothalamic-pituitary-axis by estrogen during the ovulatory phase. TAM can inhibit positive feedback to the hypothalamic-pituitary-axis by estrogen, leading to inhibition of the LH surge and then inducing the formation of a large follicular functional cyst
Mentions: Theoretically, the anti-estrogenic effects on the hypothalamic-pituitary-axis also interfere with positive feedback, leading to inhibition of the LH surge (Fig. 2). Once the LH surge occurs, granulosa cells in the mature follicles will undergo luteinization, in which the steroid hormone production shifts from estradiol to progesterone (Devoto et al. 2002). Therefore, the formation of the single functional follicular cyst that produced estradiol at more than 500 pg/mL in the serum, strongly suggests the absence of the LH surge.Fig. 2

Bottom Line: There was no significant difference in age or FSH concentration between the two groups.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8641 Japan.

ABSTRACT

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

No MeSH data available.


Related in: MedlinePlus