Endocrinol. Japon. 1990,37(6), 907-913

Calcium

Metabolism by a Gn-RH

MASAHARU

ITO,

in Premenopausal Women Treated Agonist for Uterine Myoma

YOSHIO

SAKODA

AND HITOSHI

OKAMURA

Department of Obstetrics and Gynecology, Kumamoto University Medical School, Kumamoto, Japan

Abstract Eleven

premenopausal

intranasal

women

Gn-RH

participated

agonist

in

calcium

this

study.

metabolism

assessed the

by end

sustained after

and

and

proline

to

alkaline

creatinine

The

serum

There

was

mineral

a

months

after From

metabolism

the

value

hormone

no

reduction

significant (BMC)

decrease the

these findings, during

at in

the

end

of

treatment.

BMC,

cessation this medication,

levels in of

which

showed

adverse

1

to,

the

have ones

rapidly hydroxyBoth

the

changes.

vertebral 4

out

bone

of

11

pretreatment

some in

serum

treatment.

significant

lumbar

level

effects the

3

at was

month. during

but to

to

prior

urinary

no

mean

treatment,

appears no

to

vertebrae

decreased

fasting in

returned

therapy but

the

related

evaluated

slightly

the

of

months

lumbar

levels the

increased

6

Hypo-estrogenism

increased

osteocalcin

the

were

and

300ƒÊg

for

parameters of

Calcitonin

treatment

m-parathyroid

content

showed

and

some

treatment.

period.

of excretion

phosphatase

the

received

daily

density tomography

after

treatment

weeks

who

times

estradiol,

minearal

months

the 2

myoma

three

computerized 3

during the first

uterine

Serum bone

quantitative of

with

(buserelin)

on months

cases in

3

calcium after

treatment.

Uterine myoma, the most common solid pelvic tumors in the female, are often diagnosed in 20 to 25% of premenopausal women. Of all patients diagnosed with uterine myoma in our hospital, more than 15% required gynecological surgery. Conservative medical treatment for cases complicated with severe anemia or cardiovascular Received August, 14, 1990 Address for reprints: MASAHARU ITO, M. D. Department of Obstetrics and Gynecology Kumamoto University Medical School, Honjo 1-1-1, Kumamoto 860, Japan

diseases is sometimes mandatory. Since uterine myoma are estrogen-sensitive, and a high-estrogenic state is associated with their growth, long-term administration of a gonadotrophin-releasing hormone agonist (Gn-RHa) which has been shown to reduce the serum estrogen concentration to a postmenopausal level can be therapeutically effective (Fukuma et al., 1988; Lemay et al., 1988; Friedman et al., 1989). On the other hand, it is well established that accelerated bone loss is associated with the estrogen deprivation that follows

908

ITO

Endocrinol. Japon. Decembe 1990

et al.

natural menopause or surgical oophorectomy (Lindsay et al., 1976). A side effect of long-term treatment with Gn-RHa could, therefore, be the development of osteoporosis, and few papers have fully examined the effect of the administration of Gn-RHa on bone metabolism. We evaluated bone metabolism and uterine volume in women with uterine myoma for 6 months and at 3 months after treatment with buserelin, a potent Gn-RHa.

months.

To

the treatment, department

evaluate

during and medication

Patients

with

Eleven of

myoma

women

age

tomography,

imaging,

were of

surgery

was

sound, 3.5

Bone

mineral

content

BMC measurement ately prior to and treatment. When of the treatment, once again the lumber

was

The

the to

the

top

calculated (R1)

(R2)

these

3

and

a

General

employing

the

Ultrawith RT-

initiation

weeks

of

was

of

the

the

treatment.

measured

antero-

the

part

widest

from

the

of

the

fundus.

Uterine

an

ellipsoid

by R1,

the

Medical

across

where

for obtained

equipped

as (R3),

with

Scanner,

medications

before 24

sagitally,

uterine

tomography, 9800

popu-

metabolism.

diameter

and

Trabecular BMC of assessed by quantitative

various

was

scanner

laterally,

uterus,

was decreased at the end procedure was repeated

in 3 months. vertebrae was

CT

immediGn-RHa

whom

of

(Yokogawa

after

uterine

BMC this

performed end of the

years

a

consent

received

time

performed

posteriorly,

was the

com-

for

study

had

real

and

at

resonance

because

present

transducer

treatment

of

by

from

patients

calcium

a

MHz

3600),

the

influence

with

magnetic

informed

None to

by

from

Their

writing.

52

and

selected

myoma

in

known

or

refrained

participation

to

diagnosed

echography,

uterine

safety

recorded.

Electric

35

myoma

randomly

complications.

a

from

uterine

puterized

and

uteri

examination,

lation

Methods

ranging

with

bimanual

in

and

efficacy

were seen at our out-patient month for the 9 months

after the treatment. Any change in or the occurence of side effects was

computerized

Materials

the

patients once a

os

volume

the

R2,

of

internal

was

formula

and

(ƒÎ/6)

R3

are

the

dimensions.

Protocol Prior the

to

early

the

laboratory

content

meters,

bone

thyroid

buserelin

of

insufflation

serum

(see

menstrual

[D-Ser

estradiol,

Japan)

was of

Japan

below).

three

Gn-RH

on

Gn-RHa,

NH210-LH

Months

RH

Pharmaceuticals, by times

agonist(900μg/day)

para-

Starting

cycles,

self-administered

300ƒÊg

bone paraand

(TBU)6-des-Gly (Hoechst

from

resorption

parameters,

levels

in

obtained

bone

formation

their

information

was

of

(BMC),

hormone 2

ethylamide] Tokyo,

baseline phase

investigation

mineral

day

study,

follicullar

daily

fi g.

intranasal for

6

1.

Changes

prior to treatment.

and

in at

uterine the

end

volume of

the

measured buserelin

Vol.37, Cann

and

1980) a

No.6 Genant

which

10mm

where

at

composed

bone.

radiation

the

in

to

each

of

3%,

abdominal

for in

vertebra, of

the

of

absorbed

region

is

creatinine

P/Cr).

excretion

Fasting by

U-Best

30)

measurements and

visit.

until

analyzed.

urine

All

(CT), hormone

osteocalcin (m-PTH)

mercially

available

kit, CIS;

Daiichi; PTH

phosphatase according King,

CT kit,

to 1954).

phorus, and autoanalyzer and

phosphorus

samples

were

were

Serum

estradiol

(BGP), were

collected

stored (E2),

and assayed

Daiichi;

Yamasa).

at

urinary

creatinine (Toshiba

calcitonin

a

kit total

calcium,

were measured TBS-80S), and

excretion

values

Bunko

creatinine

samples

excretion

were

assayed

in

P