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A CASE OF HYPERGONADOTROPIC HYPOGONADISM, PROGRESSIVE EARLY-ONSET SPINOCEREBELLAR ATAXIA, AND LATE-ONSET SENSORINEURAL HEARING LOSS
S84
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
Keywords: Bone mineral density, Bone Markers, North Indian Women.
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325
A CASE OF HYPERGONADOTROPIC HYPOGONADISM, PROGRESSIVE EARLY-ONSET SPINOCEREBELLAR ATAXIA, AND LATE-ONSET SENSORINEURAL HEARING LOSS
ASSESSMENT OF BASAL AND GNRH-STIMULATED GONADOTROPINS IN MENOPAUSAL DIAGNOSES E.A.M.R. Resende, B.H.J. Lara, G.A. Pereira, B.P. Ferreira, M.F. Borges. Universidade Federal do Triângulo Mineiro, Disciplina de Endocrinologia, Uberaba, Brazil Objectives: New methodologies have been applied to immunofluorometric (IFMA) and immunochemiluminometric (ICMA) LH and FSH assays. This study aimed to use ICMA to establish basal and GnRH-stimulated LH and FSH reference values in premenopausal and postmenopausal women, comparing with IFMA. Methods: We measured basal LH and FSH levels of 110 normal women. Of these, 48 (18.3-35.2 years) were cyclic premenopausal women and 62 (42-63.1 years) postmenopausal women. Of these, 22 were submitted to GnRH test, 12 in the premenopausal group and 10 postmenopausal. Results: The premenopausal upper limits for basal LH were 12.8 IU/L (ICMA) and 15.4 IU/L (IFMA), and for basal FSH were 6.7 IU/L (ICMA) and 7.3IU/L (IFMA), determined by the 95th percentiles of younger women. No overlap of basal FSH levels determined by both methods was observed between premenopausal and postmenopausal women, but basal LH levels overlapped in 6.6% and 20% of the subjects, determined by IFMA and ICMA, respectively. The FSH peak after GnRH stimulation that defined menopause was 26.1 IU/L (ICMA) and 18.8 IU/L (IFMA). However, by ICMA, overlap was observed between two groups in 6.7%. After GnRH stimulation, LH values by the two methods overlapped in both groups. Conclusions: We concluded that ICMA is more sensitive and precise than IFMA, allowing the differentiation of postmenopausal and premenopausal stages under basal conditions. We established that the levels of basal FSH for postmenopausal women were 6.7 IU/L by ICMA and 7.3IU/L by IFMA, without overlap with the group of premenopausal women. Keywords: Gonadotropins, GnRH test, Immunofluorometric and Immunochemiluminometric.
E. Sarikaya 1 , G. Ensert 2 , C. Gülerman 1 . 1 Zekai Tahir Burak Women’s Health Research and Education Hospital, Centre for Reproductive Medicine, Ankara, Turkey; 2 Zekai Tahir Burak Women’s Health Research and Education Hospital, Neurology, Ankara, Turkey Objectives: We described a woman with spinocerebellar ataxia, hypergonadotropic hypogonadism and sensorineural hearing loss. Methods: SHBG, DHEAS, prolactine, testosterone/estradiol, FSH, LH, ACTH, hCG and GnRH tests were performed. The brain was examined with magnetic resonance imaging (MRI). Auditory tests and ophthalmologic examination has been performed. Results: The index case was 24 year old female with 2 year primary infertility. She had a normal birth, infancy, and childhood. She seemed to have normal adrenarche and pubarche but when she was 23, secondary amenorrhea developed. Her symptoms began in the first decade of life with dysequilibrium, poor balance with falls and dysarthria respectively. Two years later clumsiness in writing has been developed. Later, symptoms progressed to slowing of saccadic velocity, development of up-gaze palsy, dysmetria, dysdiadochokinesia, and hypotonia. Neurological examination revealed mild dysarthria, bilaterally restricted upward and lateral eye movements, limb and gait ataxia, absent deep tendon reflexes in the legs, and clumsy hand movements. Sensorineural deafness and peripheral sensory impairment were also present. Intellect was normal. No optic atrophy was detected. MRI showed no cerebellar atrophy. The estradiol value was low and FSH and LH values were high, which indicates that the hypogonadism was of the hypergonadotropic type. The growth and pubertal development was normal. Transvaginal ultrasound showed normal uterus and ovaries. The adrenal, cortical and thyroid functions were normal. Conclusions: Cerebellar ataxia and hypergonadotropic hypogonadism comprise a rare and heterogeneous association. Inheritance in most cases appears to be autosomal recessive. Keywords: Spinocerebellar ataxia, premature ovarian failure.
326 RALOXIFEN EFFICACY IN TREATMENT OF MENOPAUSAL WOMEN WITH FIBROMYALGIA S. Sadreddini. Rheumatologist (Tabriz University of Medical Sciences), Tabriz, Iran, Islamic Republic of Objectives: This study compared Raloxifen (Evista) with placebo in the treatment of fibromyalgia. Methods: A total of 100 menopausal women with fibromyalgia enrolled between Feb 2005 until Oct 2006 entered a double-blind randomized study comparing Raloxifen, and placebo over 16 weeks of treatment.Fifty patients received Raloxifen and 49 (98%) completed the study, 50 received Placebo and 47 (94%) completed the study.Raloxifen in doses of 60 mg/every other day or identical placebo were given over 16 weeks of follows up.Improved recovery for a treatment group was assessed by a significantly higher mean score from baseline to the end of the treatment trial, compared with patients treated with placebo, on measures of Stanford Health Assessment Questionnaire (HAQ); Iranian version of hospital anxiety and depression questionnaire (IHAD); sleep disturbance; number of tender points; reduction of pain and fatigue based on visual analogue score. Results: Raloxifen produced a significantly higher response rate than placebo in treating fibromyalgia, in improving pain and fatigue symptoms, reduction in the number of tender points, sleep disturbance and recovery of activities in daily living as measured by the Stanford Health Assessment Questionnaire (HAQ). There was no effect of Raloxifen on HAD score among fibromyalgia patients. Conclusions: Given the doses of medication used in this study, Raloxifen was superior to placebo in the treatment of menopausal patients with fibromyalgia. Keywords: Fibromyalgia, Raloxifen, Menopause, Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression (HAD).
328 INCIDENCE OF MENOPAUSE RELATED SYMPTOMS- A STUDY FROM A SUBURBAN AREA OF MUMBAI, INDIA M. Shandilya 1 , H. Payal 2 . 1 University of Seychelles - American Institute of Medicine, Obstetrics and Gynecology, Mumbai, India; 2 Rajawadi Hospital, Mumbai, India Objective: To describe evidence about symptoms associated with menopause & factors influencing them among women of different SocioEconomical Status. Menopause being an inevitable part of any women’s life, its level of awareness & treatment available is unequal between women of different Societies & Countries. Method: Study of 6 months was done at Rajawadi Hospital, a Suburban center, located in Mumbai, India. A total of 50 women, aged 40-55yrs, who had undergone OPD check & treatment, were taken & surveyed regarding their Age; SocioEconomic Status, Education; Health Coverage & Awareness. They were further grouped into 3 on basis of their Socio-Economic Status. Group 1 - Low SocioEconomic Status, 40%. Group 2 - Mid SocioEconomic Status, 40%. Group 3 - High SocioEconomic Status, 20%. Data came from self-administered questionnaires asked & explained to patients in language best known to them, which included English, Hindi & Marathi. Our study excluded women who were not willing to participate & also those who had lowered educational level (<6yrs). Result: Patients widely presented with symptoms Urinary Urgency (80%), Stress Incontinence (80%); Generalized Weakness (85%) & Back Pain (90%). Out of the entire study sample, total 80% of women who demanded for relief of their complaints & agreed for regular follow-ups, were mainly from Group3 (13%) & Group2 (25%). Remaining 20%, who were unaware about symptoms & treatment available, were from Group1. Conclusion: From above study we concluded that there is a strong relationship between Socio Economical Status of woman & Awareness of incidence of Menopause related symptoms & treatment available & also
8th European Congress on Menopause (EMAS) / Maturitas 63, Supplement 1 (2009) S1–S136
Keywords: Bone mineral density, Bone Markers, North Indian Women.
327
325
A CASE OF HYPERGONADOTROPIC HYPOGONADISM, PROGRESSIVE EARLY-ONSET SPINOCEREBELLAR ATAXIA, AND LATE-ONSET SENSORINEURAL HEARING LOSS
ASSESSMENT OF BASAL AND GNRH-STIMULATED GONADOTROPINS IN MENOPAUSAL DIAGNOSES E.A.M.R. Resende, B.H.J. Lara, G.A. Pereira, B.P. Ferreira, M.F. Borges. Universidade Federal do Triângulo Mineiro, Disciplina de Endocrinologia, Uberaba, Brazil Objectives: New methodologies have been applied to immunofluorometric (IFMA) and immunochemiluminometric (ICMA) LH and FSH assays. This study aimed to use ICMA to establish basal and GnRH-stimulated LH and FSH reference values in premenopausal and postmenopausal women, comparing with IFMA. Methods: We measured basal LH and FSH levels of 110 normal women. Of these, 48 (18.3-35.2 years) were cyclic premenopausal women and 62 (42-63.1 years) postmenopausal women. Of these, 22 were submitted to GnRH test, 12 in the premenopausal group and 10 postmenopausal. Results: The premenopausal upper limits for basal LH were 12.8 IU/L (ICMA) and 15.4 IU/L (IFMA), and for basal FSH were 6.7 IU/L (ICMA) and 7.3IU/L (IFMA), determined by the 95th percentiles of younger women. No overlap of basal FSH levels determined by both methods was observed between premenopausal and postmenopausal women, but basal LH levels overlapped in 6.6% and 20% of the subjects, determined by IFMA and ICMA, respectively. The FSH peak after GnRH stimulation that defined menopause was 26.1 IU/L (ICMA) and 18.8 IU/L (IFMA). However, by ICMA, overlap was observed between two groups in 6.7%. After GnRH stimulation, LH values by the two methods overlapped in both groups. Conclusions: We concluded that ICMA is more sensitive and precise than IFMA, allowing the differentiation of postmenopausal and premenopausal stages under basal conditions. We established that the levels of basal FSH for postmenopausal women were 6.7 IU/L by ICMA and 7.3IU/L by IFMA, without overlap with the group of premenopausal women. Keywords: Gonadotropins, GnRH test, Immunofluorometric and Immunochemiluminometric.
E. Sarikaya 1 , G. Ensert 2 , C. Gülerman 1 . 1 Zekai Tahir Burak Women’s Health Research and Education Hospital, Centre for Reproductive Medicine, Ankara, Turkey; 2 Zekai Tahir Burak Women’s Health Research and Education Hospital, Neurology, Ankara, Turkey Objectives: We described a woman with spinocerebellar ataxia, hypergonadotropic hypogonadism and sensorineural hearing loss. Methods: SHBG, DHEAS, prolactine, testosterone/estradiol, FSH, LH, ACTH, hCG and GnRH tests were performed. The brain was examined with magnetic resonance imaging (MRI). Auditory tests and ophthalmologic examination has been performed. Results: The index case was 24 year old female with 2 year primary infertility. She had a normal birth, infancy, and childhood. She seemed to have normal adrenarche and pubarche but when she was 23, secondary amenorrhea developed. Her symptoms began in the first decade of life with dysequilibrium, poor balance with falls and dysarthria respectively. Two years later clumsiness in writing has been developed. Later, symptoms progressed to slowing of saccadic velocity, development of up-gaze palsy, dysmetria, dysdiadochokinesia, and hypotonia. Neurological examination revealed mild dysarthria, bilaterally restricted upward and lateral eye movements, limb and gait ataxia, absent deep tendon reflexes in the legs, and clumsy hand movements. Sensorineural deafness and peripheral sensory impairment were also present. Intellect was normal. No optic atrophy was detected. MRI showed no cerebellar atrophy. The estradiol value was low and FSH and LH values were high, which indicates that the hypogonadism was of the hypergonadotropic type. The growth and pubertal development was normal. Transvaginal ultrasound showed normal uterus and ovaries. The adrenal, cortical and thyroid functions were normal. Conclusions: Cerebellar ataxia and hypergonadotropic hypogonadism comprise a rare and heterogeneous association. Inheritance in most cases appears to be autosomal recessive. Keywords: Spinocerebellar ataxia, premature ovarian failure.
326 RALOXIFEN EFFICACY IN TREATMENT OF MENOPAUSAL WOMEN WITH FIBROMYALGIA S. Sadreddini. Rheumatologist (Tabriz University of Medical Sciences), Tabriz, Iran, Islamic Republic of Objectives: This study compared Raloxifen (Evista) with placebo in the treatment of fibromyalgia. Methods: A total of 100 menopausal women with fibromyalgia enrolled between Feb 2005 until Oct 2006 entered a double-blind randomized study comparing Raloxifen, and placebo over 16 weeks of treatment.Fifty patients received Raloxifen and 49 (98%) completed the study, 50 received Placebo and 47 (94%) completed the study.Raloxifen in doses of 60 mg/every other day or identical placebo were given over 16 weeks of follows up.Improved recovery for a treatment group was assessed by a significantly higher mean score from baseline to the end of the treatment trial, compared with patients treated with placebo, on measures of Stanford Health Assessment Questionnaire (HAQ); Iranian version of hospital anxiety and depression questionnaire (IHAD); sleep disturbance; number of tender points; reduction of pain and fatigue based on visual analogue score. Results: Raloxifen produced a significantly higher response rate than placebo in treating fibromyalgia, in improving pain and fatigue symptoms, reduction in the number of tender points, sleep disturbance and recovery of activities in daily living as measured by the Stanford Health Assessment Questionnaire (HAQ). There was no effect of Raloxifen on HAD score among fibromyalgia patients. Conclusions: Given the doses of medication used in this study, Raloxifen was superior to placebo in the treatment of menopausal patients with fibromyalgia. Keywords: Fibromyalgia, Raloxifen, Menopause, Health Assessment Questionnaire (HAQ), Hospital Anxiety and Depression (HAD).
328 INCIDENCE OF MENOPAUSE RELATED SYMPTOMS- A STUDY FROM A SUBURBAN AREA OF MUMBAI, INDIA M. Shandilya 1 , H. Payal 2 . 1 University of Seychelles - American Institute of Medicine, Obstetrics and Gynecology, Mumbai, India; 2 Rajawadi Hospital, Mumbai, India Objective: To describe evidence about symptoms associated with menopause & factors influencing them among women of different SocioEconomical Status. Menopause being an inevitable part of any women’s life, its level of awareness & treatment available is unequal between women of different Societies & Countries. Method: Study of 6 months was done at Rajawadi Hospital, a Suburban center, located in Mumbai, India. A total of 50 women, aged 40-55yrs, who had undergone OPD check & treatment, were taken & surveyed regarding their Age; SocioEconomic Status, Education; Health Coverage & Awareness. They were further grouped into 3 on basis of their Socio-Economic Status. Group 1 - Low SocioEconomic Status, 40%. Group 2 - Mid SocioEconomic Status, 40%. Group 3 - High SocioEconomic Status, 20%. Data came from self-administered questionnaires asked & explained to patients in language best known to them, which included English, Hindi & Marathi. Our study excluded women who were not willing to participate & also those who had lowered educational level (<6yrs). Result: Patients widely presented with symptoms Urinary Urgency (80%), Stress Incontinence (80%); Generalized Weakness (85%) & Back Pain (90%). Out of the entire study sample, total 80% of women who demanded for relief of their complaints & agreed for regular follow-ups, were mainly from Group3 (13%) & Group2 (25%). Remaining 20%, who were unaware about symptoms & treatment available, were from Group1. Conclusion: From above study we concluded that there is a strong relationship between Socio Economical Status of woman & Awareness of incidence of Menopause related symptoms & treatment available & also