Estrogen therapy administration

HRT (hormone replacement therapy) administration of estrogens to women or androgens to men who, due to menopause or age, have decreased levels of these plasma steroids. 

Exacerbations of other conditions Endometriosis may be exacerbated with administration of estrogen therapy. Estrogen therapy also may cause an exacerbation of asthma, diabetes mellitus, epilepsy, migraine, or porphyria use with caution in patients with these conditions. 

Interpretation In normal subjects, serum cortisol concentration is suppressed to 2 pg/dL or less after administration of 1 mg of dexamethasone. Most patients with Cushing s syndrome do not show adequate suppression, and 0800 hours cortisol concentrations are usually >10pg/dL. Serum cortisol >2pg/dL may also be seen in cases of stress, obesity, infection, acute or chronic illness, alcohol abuse, severe depression, oral contraceptive use, pregnancy, estrogen therapy, failure to take the dexamethasone, or treatment with phenytoin or phenobarbital (enhancement of dexamethasone metabolism). 

Exemestane is an irreversible aromatase inactivator that binds to the aromatase enzyme to block the production of estrogen from androgens. Exemestane is absorbed rapidly after oral administration, with a terminal half-life of 24 hours. The drug is eliminated primarily by the liver and feces, with less than 1% of the dose excreted unchanged in the urine. Exemestane is indicated for the treatment of advanced breast cancer in postmenopausal women who have had disease progression following tamoxifen therapy. Side effects include hot flashes, fatigue, osteoporosis/bone fractures, and flulike symptoms. 

Estrogen is more effective than any other therapy in relieving vasomotor symptoms, and all types and routes of systemic administration are equally effective in a dose-dependent fashion. If treatment can be tapered and stopped within 5 years, no evidence of increased risk of breast cancer is seen. 

High-dose progestins are used as last-line endocrine therapy [223]. They inhibit the adrenal steroid biosynthesis. The decrease of estrogen levels is comparable to that caused by the administration of aromatase inhibitors. In post-menopausal women, the progestin megestrol acetate (MGA) decreases serum plasma level of DEAH, androstenedione and cortisol to less than 10% [223,224]. 

Alternatives to steroid hormone therapy for osteoporosis include raloxifene, bisphosphonates, sodium fluoride, vitamin D and calcium supplementation, calcitonin, and parathyroid hormone. Tamoxifen has estrogenic effects on bone and delays bone loss in postmenopausal women. However as a result of estrogenic activity in the uterus, long-term tamoxifen administration has been associated with an increased risk of... 

Estrogen receptor-positive breast cancer in premenopausal and postmenopausal women responds equally to tamoxifen therapy (see Chapter 58). In addition, daily tamoxifen administration for 5 years is a successful therapy for the prevention of breast cancer in the contralateral breast in women who have already had one episode of breast cancer. 

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