Pituitary radiation for the relief of menopause symptoms

Pituitary radiation for the relief of menopause symptoms

GEIST-MINTZ; RADIATION FOR RELIEF OF ::VIENOPAUSE SYMPTOMS 643 U])On, and whose condition clears up after the strieture is dilated. Bunner has show...

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GEIST-MINTZ;

RADIATION FOR RELIEF OF ::VIENOPAUSE SYMPTOMS

643

U])On, and whose condition clears up after the strieture is dilated. Bunner has shown a number of pathologic speeimens in which he demonstrated Yery defmitely ureteral stricture. That strictures occur as as he believes, I doubt, because it seems to me that when a catheter is introduced into the meter, there is apparently a stricture one time and later a perfectly normal ureter.

DR. LIKTGEN (closing).-We do not feel that a diagnosis can be made with a No. 6 catheter. I believe that if a No. 9 or No. 10 will pass without reproduc· tion of pain or without a tug v>hen it is withdrawn that there is no stricture present. \Ve do not feel that a wax bulb is essential for diagnosis. Intravenous pyelography does not always tell us the truth because in some cases where the pyelogram was normal, the symptoms cleared up after dilating the ureter. I have not, however, listed any of those cases in my series.

PITUITARY RADIATION FOR THE RBI1lEF OF MENOPAUSE SYMPTOMS SA::VI1JEL

H.

GEIS1',

:VLD.,

A...~D MAURICE 1\:hNTZ,

M.D.,

(From the Out-Patient Department Gynecological Service,

NEW YORK,

~Mo·v;nt

N.

Y.

Sina·i Hospital)

URING the last t,en years three thousand cases were observed in the Dmenopause clinic at Mount Sinai Hospital, and we desire to tabulate

the response of this large group to various therapeutic measures. INe ·were impressed by the fact that many patients, >vho regularly menstruated, complained of severe symptoms including flushes, sweats, and other vasomotor and psychic disturbances, as well as those whose menstruation had long ceased. It has been pointed out by Fluhmann and others that there is an increase in excretion of gonadotropic hormone during the menopause. This may be present with or "\'V'ithout unusual vasomotor or psychic disturbances. It has also been shown that an estrogenic hormone may be present in the blood and urine during the menopause, even in those instances where symptoms are pronounced. It is evident that factors other than the withdrawal of estrin or the increase of gonadotropic hormone must be considered as active in the production of symptoms. We do know that following castration, and in the menopause, definite histologic changes, more or less constant, are found in the pituitary. The gland is enlarged and contains the so-called castration cells. It would seem logieal that if the pituitary secreted not only an excess of gonadotropic hormone but some other factor, any method that would reduce this excess secretion might be helpful and might control, at least to some extent, the distressing symptoms of the menopause. It has long been suggested by many inYestigators that the exhibition of estrogenic factor would prove of benefit in the treatment of the menopause syndrome. 'I'his has proved to be so, and the result of treatment in a great many cases has been satisfactory. We have noticed that a certain proportion

644

A3:IERJCA::\ ,JOUR~AI, OF O.BS'l'E'l'RIC8 .AND GYNECOLOGY

of patients treatment with estrogenic factor were not benefited, and it was decided to radiate the pituitary in these cases with the expectation of reducing the pituitary activity, and thus possibly relieving these patients of their symptoms. In two cases studied by Dr. Spielman he failed to find an appreciable variation in the gonadotropic hormone excreted after the pituitary radiation. However, these tests were carried out at a time when methods of determination were rather crude, so that definite conclusions cannot be drawn. In addition to these two observations, one of us (S. H. G.) had an occasion to study the histology of a pituitary which had been carefully and extensively radiated for a basophilic adenoma. The examination of the gland failed to reveal any histologic changes that could not be accounted for by the sex and age of the patient. However, it is possible that a gland may be physiologicalJy abnormal \vithout this abnormality reflecting itself in a detectable histologic change. Because of the apparent role played by the pituitary in the production of the menopausal syndrome, it has been suggested that x-ray therapy, directed toward reducing the activity of the pituitary or in some other way in" :fluencing its activity, might be beneficial. Groedel of Nauheim originally suggested radiation of the ovary in the menopause and reported good results. Subsequently Werner of the Vienna school employed radiation of the pituitary and thyroid either alone or in combination and also ob· tained ·good results. Borak and Grabowski also suggested that the combination of pituitary and thyroid radiation might give better results than either alone. Gold· hammer and Blass stated that the pituitary radiation does not effect the excretion of gonadotropic hormone in the urine. In addition they had one case in which they could study the morphologic changes in the pituitary gland following radiation but were unable to detect any variation from the normal. Numerous other authors have had similar experiences and results. Collins and his coworkers reported a series of cases, with encouragir1g results. It muat be noted that the follow-up obserYations in many instances were not of sufficient duration to permit conclusions as to the per· manency of the results. In some of the cases a second series of treatments was necessary, and Collins has reported that in this group he obtained permanent success.

We treated a series of 75 patients and in addition utilized an additional 25 cases as controls. The control group was exposed in exactly the same manner as the patients receiving actual treatment except that the rays were screened out. Only one of the 25 control patients reported that she felt better for a few weeks. The other 24 had no beneficial effect. The technic employed at Mount Sinai Hospital was as follows:

GEIST-MINTZ:

&<\.DIATION FOR, RELIEF OF MENOPAUSE SYMPTOMS

645

In the 75 patients treated, there was an equal number of natural and artificial menopause cases. In the artificial menopausal group there was approximately an equal number of surgical and x-ray castrations. We have followed these patients for a period of over two years. RESULTS

Ninety per cent of the patients lost the hair about the temporal region. In 85 per cent of the cases, sweating, a very common symptom, was markedly decreased and in 20 per cent completely disappeared. Seventyfive per cent of the patients claimed a moderate diminution in the :frequency of the flushes. Some stated that after having had 15 to 20 flushes daily they were completely relieved. In 50 per cent of the cases, headaches, either frontal or occipital, were relieved and in some instances apparently cured. In 25 per cent general nervousness and dizziness apparently improved. Palpitation on exertion was relieved in about 10 per cent. The outstanding symptom that was not ameliorated to any degree was the pseudarthritic pain so commonly present. All the above improvements lasted from two to six weeks following a series of three x-ray treatments. The symptoms then gradually returned, though in some instances not as marked as before treatment. It was necessary to continue treatment and in six instances seven series of treatments were given, amounting to twenty-one exposures. Following each series given, an amelioration of s,ymptoms for about six weeks resulted. It was deemed unwise to attempt any additional radiotherapeutic treatment. ~'hese patients, when symptoms recurred after the limit of x-ray was given, received injections of progynon-B with marked benefit. This series of patients treated with progynon-B will be reported upon at a later date. Six patients had vaginal bleeding after one application of x-ray to the pituitary. Whether or not this indicates a stimulation of ovarian function through the hypophysis is purely hypothetical. The results obtained by x-ray treatment apparently were in no way dependent upon the duration of menopause. To summal'ize, we can say that radiation of the pituitary gland with the technic indicated will invariably relieve the patient :for a period of f'rom two to six weeks. The treatment is limited because only a restricted number of exposures can be given. The result of treatment indicates that there is a relationship between the pituitary and menopause s;yndrome. REFERENGES

Fluhmann, 0. F.: J. A.M. A. 93: 672, 1929. Groedel: Miinchen. med. Wchnschr. 09: 423, 1922. Werner: Ztschr. f. Geburtsh. u. Gynak. 31: 1923. Borak: Brit. J. Hadiol. 23: 293, 1924. Collins, Thomas, and Menville: AM. J. 0BST. & GYNEC. 31: 115, 1936. G~·abow.~lci, W.: J. A. M. A. 98: 269, 1931. Goldhammer an(l Blass: Zur Rontgentherapie der Klimakterisehen Besehwerden, Strahlentherapie 119: 1211. 1923. ' 100

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