Hyperplasia hormone replacement

Saw palmetto (cabbage palm, fan palm, scrub palm) Serenoa repens %mptoms of benign prostatic hyperplasia Generally well-tolerated occasional gastrointestinal effects May interact with hormones such as oral contraceptive drugs and hormone replacement therapy. 

Hormone replacement therapy PO 5-lOmgfor 12-14 consecutive days a month, beginning on day 1 or 16 of cycle given as parf of regimen with conjugated estrogens. Endometrial hyperplasia PO 2.5-10 mg/day for 14 days. 

Lethaby A, Suckling J, Barlow D, Farquhar CM, Jepson RG, Roberts H. Hormone replacement therapy in postmenopausal women endometrial hyperplasia and irregular bleeding. Cochrane Database Syst Rev 2004 (3) CD000402. 

Note that pituitary enlargement in hypothyroidism does not invariably indicate the presence of a primary pituitary tumor. Pituitary enlargement is seen in patients with severe primary hypothyroidism owing to compensatory hyperplasia and hypertrophy of the thyrotrophs. Serum TSH concentrations and pituitary enlargement decline during thyroid hormone replacement therapy, indicating that the TSH secretion is not autonomous. These patients are easily separated from patients with primary pituitary failure by measuring a TSH level. 

Because many enzyme systems are needed to complete the complex cholesterol-to-cortisol pathway, enzyme deficiencies may lead to disruptions of the normal cascade of events (see Fig. 74—2). This group of enzyme disorders is known as congenital adrenal hyperplasia, mainly because of the resultant chronic adrenal gland stimulation that occurs following enzyme deficiency. The most frequent is steroid 21-hydroxylase deficiency, accounting for more than 90% of cases. Any enzyme deficiency is capable of affecting any one or all three of the steroid pathways. Therefore treatment should be focused on replacement of the deficient hormone, as well as cessation of the chronic stimulation causing the hyperplasia. In Table 74—8, six of the most common enzyme deficiencies are briefly outlined. 

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