Treatment hormone therapy

The measurement of ER has become a standard assay in the clinical management of breast cancer. The presence of ERa identifies those breast cancer patients with a lower risk of relapse and better clinical outcome. Receptor status also provides a guideline for those tumors that may be responsive to hormonal intervention. But only about half of ER-positive patients respond to hormonal therapies. Of those who respond initially, most will eventually develop an estrogen unresponsive disease following a period of treatment even though ERa is often still present. Mutant receptors and constitutively active r eceptors as well as hormone-independent activation of the ERa are discussed. The involvement of ER 3 isoforms is under investigation. 

Recombinant growth hormone therapy is the main pharmacologic treatment for growth hormone deficiency in both children and adults. 

HRT, but they are less efficacious than hormonal therapies. Alternative treatments should be chosen based on the efficacy and safety profile of the treatment and the patient s past medical history and current medications. 

Hormonal therapies have shown activity in the treatment of cancers whose growth is affected by gonadal hormonal control. Hormonal treatments either block or decrease the production of endogenous hormones. 

Hormonal therapies that have been studied in the treatment of primary or early breast cancer include antiestrogens, oophorectomy, ovarian irradiation, luteinizing hormone-releasing hormone (LHRH) agonists, and aromatase inhibitors. 

There are no well-defined clinical characteristics or established tests to identify patients likely to benefit from chemotherapy. Factors associated with an increased probability of response that have been identified include a good performance status, a limited number (one to two) of disease sites, and patients who respond to chemotherapy or hormonal therapy with a long disease-free interval. Patients who have progressive disease during chemotherapy have a lower probability of response to a different type of chemotherapy. However, this is not necessarily true for patients who are given chemotherapy after some interval during which they have received no chemotherapy. Patients who do not respond to endocrine therapy are as likely to respond to chemotherapy as patients who are treated with chemotherapy as their initial treatment modality. Age, menopausal status, and receptor status have not been associated with favorable or unfavorable response to chemotherapy. 

Prostate cancer treatment depends on the stage, age, Gleason score, and PSA concentration. Treatment options include expectant management, radiation therapy, radical prostatectomy, hormonal therapy, and chemotherapy. 

Oh WK. Secondary hormonal therapies in the treatment of prostate cancer. Urology 2002 60(3 suppl 1) 87—92. 

Hormonal therapy can be an effective treatment in females affected by inflammatory acne. Different varieties of hormonal therapies are... 

Oral isotretinoin is the treatment of choice in severe papulopustular acne and nodulocystic/conglobate acne. Hormonal therapy may be an effective alternative in female patients. 

Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. Perimenopause is the period immediately prior to the menopause and the first year after menopause. Indications of postmenopausal hormone therapy include the short-term treatment of menopausal symptoms (i.e., hot flushes, night sweats, and urogenital atrophy). 

Most women with vasomotor symptoms need hormone treatment for less than 5 years. Without treatment, hot flushes usually disappear within 1 to 2 years. Hormone therapy can usually be tapered and stopped after about 2 or 3 years. 

According to results from clinical trials, the agonistic effects of tamoxifen detected in animals were also observed in the human uterus as it produces a trophic effect and an increase in the incidence of endometrial pathology, which is related to endometrial thickening (> 4 mm). Its use seems to be associated with an increase in endometrial cancer, which is related to the length of treatment and the accumulated dose of tamoxifen. Nevertheless, these tumors do not seem to be more aggressive or to have a worse prognosis than those found in women who do not follow this treatment or who receive hormone therapy. 

It is not, however, efficient in the treatment of hepatocarcinoma. Nowak et al. (2004), in a review by Cochrane, pointed out that the available data do not support the use of tamoxifen for patients with hepatocellular carcinoma. This same conclusion was reached by Gerard and Bleiberg (2004), who stated that hormonal therapy with tamoxifen or antiandrogens had shown no efficacy and might even be detrimental in patients with hepatocarcinoma. 

Jenkins V, Shilling V, Fallowfield L, Howell A, Hutton S (2004) Does hormone therapy for the treatment of breast cancer have a detrimental effect on memory and cognition A pil study. Psychooncology 13 61-66... 

Hormone therapy has proven highly effective in controlling the menopausal syndrome, especially severe hot flushes (MacLennan et al. 2004), even at doses significantly lower than those used until now (Speroff et al. 2000 Utian et al. 2001). Women s Health Initiative studies found that hormone replacement therapy, when administered as a primary prevention intervention for CVD in older women, increases the risk of heart disease and breast cancer. Even if a protective effect on fracture and colon cancer was observed, the risk-benefit ratio led to a recommendation of this treatment only for the short-term relief of menopausal symptoms (Rossouw et al. 2002 Anderson et al. 2004). The role of early administration of ovarian hormones to young postmenopausal women in the prevention of cardiovascular disease or late dementia remains... 

Infertility Thyroid hormone therapy is unjustified for the treatment of male or female infertility unless the condition is accompanied by hypothyroidism. 

Autoimmune polyglandular syndrome-Chron c autoimmune thyroiditis may occur in association with other autoimmune disorders. Treat patients with concomitant adrenal insufficiency with replacement glucocorticoids prior to initiation of treatment. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens. Nontoxic diffuse goiter or nodular thyroid disease Use caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis. If the serum TSH is already suppressed, do not administer levothyroxine. 

Additionally, MMPIs are not expected to replace currently used, proven-effective modalities of cancer treatment such as radiotherapy, hormonal/chemotherapy, or surgery. It is predicted that they will be clinically developed for use in combination with these agents. As expected, given nonoverlapping toxicities and differing mechanisms of action, MMPIs have been combined preclinically with radiation therapy (4), cytotoxic (5-9), resultant additive or supraadditive efficacy. With these data in mind, the ability to combine an MMPI with radiation therapy, chemotherapy, and hormonal therapy may become an important feature in the ultimate clinical success of these agents. 

The successful response of breast cancers to tamoxifen or progestin treatment depends on the presence of high-affinity receptors for estrogen, progesterone, or both. Fewer than 10% of mammary tumors that lack detectable ER levels will respond to hormonal therapies. Determination of hormone receptor levels in tumor samples is highly recommended before selecting a therapy. 

B) Estrogen treatment is an acceptable form of hormonal therapy. 

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