Estrogen monitoring

Elevated blood pressure In a small number of case reports, substantial increases in blood pressure have been attributed to idiosyncratic reactions to estrogens. Monitor blood pressure at regular intervals with estrogen use. 

McCarthy, A.R., Thomson, B.M., Shaw, I.C., and AbeU, A.D. (2006). Estrogenicity of pyre-throid insecticide metabolites. Journal of Environmental Monitoring 8, 197-202. 

As an example of suspected endocrine disruptors (EDs), studies of the estrogenic action of bisphenol A (BPA) have been in progress in medical, physiological, and biological fields. In this situation, physicochemical approaches are required to get the structural information of BPA trapped in biomembranes. Most recently, we have determined the site and the orientation of BPA trapped in phospholipid vesicles by NMR, using the HCS rule [47]. In particular, we have succeeded in monitoring the NMR spectral changes of phospholipid vesicles, which are induced by the BPA delivery. 

Baronti C, Curini R, D Ascenzo G, Di Corcia A, Gentili A, Samperi R (2000) Monitoring natural and synthetic estrogens at activated sludge sewage treatment plants and in a receiving river water. Environ Sci Technol 34 5059-5066... 

CHCs, even those with less than 35 meg estrogen, can cause small increases in blood pressure (6 to 8 mm Hg) in both normotensive and hypertensive women. In women with hypertension, OCs have been associated with an increased risk of MI and stroke. Use of CHCs is acceptable in women younger than 35 years with well-controlled and monitored hypertension. Hypertensive women with end-organ disease or who smoke should not use CHCs. Progestin-only pills and depot medroxyprogesterone acetate (DMPA) are choices for women with hypertension. 

With estrogen-based therapy, there should be yearly breast exams, monthly breast self-examinations, and periodic mammograms. Women on hormonal therapy should undergo annual monitoring, including pelvic examination, blood pressure checks, and routine endometrial cancer surveillance. 

In STP effluents, total extractable estrogens and conjugates have been detected at levels up to 1 /jg/L [9,11,26]. Despite the wide variability in terms of removal efficiency reported for different WWTPs, a general trend has been observed with respect to the identity of the compounds most frequently detected in WWTP effluents. Thus, of the various compounds most commonly monitored - namely, estradiol, its metabolites estriol and estrone, and the synthetic estrogen ethynylestradiol - estrone is the most ubiquitous both in WWTP effluents and in environmental waters in general, while the most potent estrogens estradiol and ethynylestradiol have only occasionally been detected [26,40-42]. As for the conjugates, the very few studies that have attempted their determination pointed out estrone sulfates as the most abundant, while glu-curonides are most often found below the limit of detection [26,36,38,39]. 

Hypercalcemia Carefully monitor standard hypercalcemia-related metabolic parameters, such as serum levels of calcium, phosphate, and magnesium, as well as serum creatinine. Do not use loop diuretics until the patient is adequately rehydrated use with caution in combination with zoledronic acid in order to avoid hypocalcemia. Use zoledronic acid with caution with other nephrotoxic drugs. Concomitant use with estrogen/hormone replacement therapy (alendronate) Two clinical studies have shown that the degree of suppression of bone turnover (as assessed by mineralizing surface) was significantly greater with the combination than with either component alone. 

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