Čiaplinskienė, Lina

Background. Mosaic karyotype 45,X/46,XY related mixed gonadal dysgenesis. Aim. To report a case of mosaic karyotype and petroclival meningioma. Methods. Presentation of a clinical case with comments. Results. The case of a 37-year-old woman mosaic karyotype - 45,X/46,XY, infertility, virilisation, Turner syndrome-like phenotype, primary amenorrhea, the absence of labia majora and petroclival meningioma. Concentrations of dehydroepiandrosterone sulphate (DHEAS), testosterone, luteinizing hormone (LH) and follicular stimulating hormone (FSH) were increased indicating hypergonadotropic hypogonadism. Low and high dose dexamethasone suppression tests demonstrated incomplete suppression of DHEAS concentration without connection between pulses of LH/FSH and DHEAS. Response to adrenocorticotropic hormone (ACTH) was normal. The morning/evening concentration ratio of DHEAS was very low in comparison with cortisol, ACTH and testosterone. Head magnetic resonance imaging (MRI) demonstrated petroclival meningioma without any adrenal or ovary abnormality. Menstruation started after treatment with 2 mg of estradiol. At control visit 1.5 years later she had no complaints. MRI did not demonstrate any signs of tumour progression. Conclusions. The main lesson learned from this case is that in searching the DHEAS secreting tumours one can find unusual cases with sustained high DHEAS and lack of confirmations of polycystic ovary syndrome, adrenal or ovary tumours using available ultrasound, CT and MRI.

Objective: to reveal the clinical importance of dehydroepiandrosterone sulphate (DHEAS) in female. Methods: A retrospective study on 378 clinical history cases of women was performed in Lithuania during 2014. In order to stratify women according to their DHEAS level the ratio was used. It was found dividing the concentration of DHEAS of the patient by highest concentration of DHEAS presented in assay kit, adjusted for age. We divided patients into two categories. Patients with DHEAS ratio R<1 belonged to the group with normal DHEAS and patients with DHEAS ratio R>1 belong to the group with increased DHEAS. Result(s): Most frequent referral age for women was between 15-44 years (71%). The reasons for referral in women for DHEAS assessement were menstrual cycle disorders (22%), hirsutism (18%), infertility (8%), weight gain (6%), high blood pressure (6%), adrenal tumors (4%), polyctic ovary syndrome (POS) (4%). It was found that DHEAS ratio R>1 were more frequent as concerning hirsutism, weight gain, adrenal tumors and POS but not menstrual cycle disturbances and infertility. 4 clinical cases will be presented. Case 1. A 38-year-old woman considered as dehidroepiandrosteroma, since she had a multitude of clinical symotoms, very high DHEAS and testosterone, evidence of adrenal tumor and complete disappearance of symptoms and normalizing of hormonal status after surgery. Case 2. A 37-year-old woman with the Turner syndrome-like characteristics and a clearly description of a patient with idiopathic hyperdehydroepiandrosteronism–constantly high DHEAS without evidence of tumoral DHEAS sourse. Case 3. A 22-year-old woman with constantly high DHEAS considered as polycystic ovary syndrome. Case 4. A 52-year-old woman with constantly high DHEAS and adrenal carcinoma discovered. Conclusions: High DHEAS was related to hirsutism, weight gain, adrenal tumors and POS.

Tikslas Įvertinti sudėtinių kontraceptinių tablečių įtaką androgenų koncentracijos pokyčiams ir moters seksualinei funkcijai. Metodai. Tyrime dalyvavo 18–40 m. moterys, turinčios reguliarius menstruacijų ciklus (22-35 dienos), kurios kreipėsi į gydytoją akušerį–ginekologą Kauno mieste dėl kontracepcijos nuo 2013 m. iki 2015 m. Į tyrimą įtrauktos 139 moterys, kurioms atsitiktinai skirtas vienas iš dviejų Lietuvoje registruotų SKT preparatų: IV kartos SKT (EE 0,03 mg/DRSP 3 mg) arba II kartos SKT (EE 0,03 mg/LNG 0,15 mg). Tyrimą sudarė 3 vizitai: įtraukimo į tyrimą (I vizitas), praėjus 3 mėnesiams (II vizitas) ir praėjus 6 mėnesiams (III vizitas). Seksualinė funkcija vertinta I, II ir III vizitų metu, naudojant Moterų lytinės funkcijos klausimyną(angl. TheFemaleSexualFunctionIndex, FSFI). I ir III vizito metu buvo paimta kraujo lytinių hormonų (LHSB, T, LT, DHEAS) tyrimams. LAI apskaičiuotas, naudojantformulę:LAI=T (nmol/l ) x 100/LHSB (nmol/l). Rezultatai. I vizito metu lytinių hormonų koncentracijos reikšmingai nesiskyrė lyginant II ir IV kartos SKT vartotojas. III vizito metu EE/LNG grupėje nustatytas reikšmingai didesnis LAI lyginant su EE/DRSP grupe (V 3,20±SN 2,59 vs V 1,89±SN 1,99; p=0,009). DHEAS, T, ir LT reikšmingai nesiskyrė tarp SKT grupių III vizito metu (1 Lentelė). [...].

INTRODUCTION: There have been few cases of hypersecretion of dehydroepiandrosterone sulfate DHEAS and adrenal tumor reported, and even fewer studies performed. OBJECTIVE: To analyze the referrals, clinical data and the effect on clinical decisions in women with different DHEAS concentrations. MATERIAL AND METHODS: A retrospective study of clinical history cases. RESULTS: There were 427 thoroughly examined cases. Maximal frequency of referral of women was in 15-44 years (71%), but 0 – 24 years (77%) in men. Age adjusted DHEAS was statistically lower in men as compared with women in ages of 0-14, 15-24, 65+, and totally. It did not differ significantly between men and women in age of 25-34, 35-44, 45-54, 55-64 and totally 25-64 years. Body weight and BMI, frequency of hirsutism and acnea, testosterone concentration but not menstrual cycle disturbances were higher in hyperdehydroepiandrosteronism. Frequency of abdominal ultrasonography, adrenal computer tomography or/and magnetic resonance imaging was the same in normal and high DHEAS groups. CONCLUSIONS: Women with increased DHEAS were statistically significantly younger, had higher weight, BMI and a higher rate of hirsutism, acnea and weight gain. Even when high DHEAS was detected, this had no impact on doctors’ decision to increase number of adrenal imaging investigations.

INTRODUCTION: After Matulevicius et al (2014) described a women, which had hypersecretion of dehydroepiandrosterone sulfate (DHEAS) and multiple clinical symptoms, we started to look retrospectively for more cases with high DHEAS in women.OBJECTIVE: To report a clinical case of mixt gonadal dysgenesis with specific karyotype and petroclival meningioma, labia majora agenesis and idiopathic hyperdehydroepiandrosteronism (DEHISM). MATERIAL AND METHODS: Presentation of clinical case with comments. RESULTS: A woman of 37 years old was referred with diagnosed primary amenorrhea and infertility. Physical examination showed Turner syndrome-like clinical characteristics and virilisation. 5 years ago petroclival meningioma was diagnosed. Gynecologically, clitoromegaly was found with absence of labia majora. Karyotype was - mos. 45, X [32] / 46, XY [10]. X monosomy was found in 76% of cell clones and 24% of cells had a male karyotype. High concentrations of gonadotropins, DHEAS and testosterone were detected. Imagine tests showed no specific tumors in adrenal glands. The ovaries were involutional, without any signs of malignancy. High DHEAS concentration cause remained unknown. CONCLUSION: Described woman had mixed gonadal dysgenesis, mosaicismal karyotype, petroclival meningioma, labia majora agenesis and DEHISM.This pathology is characterized by sustained DHEAS hypersecretion without identification of adrenal/ovary tumor with available imaginative technics.

[...]. Darbo tikslas ir uždaviniai. Darbo tikslas. Įvertinti sudėtinių kontraceptinių tablečių įtaką metaboliniams ir androgenų koncentracijos poslinkiams, kraujo krešumo rodikliams, moters nuotaikos svyravimams ir seksualinei funkcijai. Darbo uždaviniai: 1. Nustatyti sudėtinių kontraceptinių tablečių poveikį antropometriniams, metaboliniams, kraujo krešumo rodikliams, lytinių hormonų koncentracijai moters organizme ir įvertinti antrosios ir ketvirtosios kartos sudėtinių kontraceptinių tablečių poveikio skirtumas. 2. Įvertinti sudėtinių kontraceptinių tablečių vartojimo sąsajas su kiaušidžių ir skydliaukės tūrio pokyčiais. 3. Įvertinti sudėtinių kontraceptinių tablečių poveikį moters nuotaikai, seksualinio gyvenimo kokybei ir nustatyti skirtumus, lyginant antrosios ir ketvirtosios kartos sudėtinių kontraceptinių tablečių vartotojas. 4. Įvertinti hirsutizmo, androgenų koncentracijos, androgenų receptoriaus geno polimorfizmo sąsajas su seksualinės funkcijos pokyčiais tarp moterų, vartojančių sudėtines kontraceptines tabletes, ir palyginti šių pokyčių skirtumas tarp antrosios ir ketvirtosios kartos sudėtinių kontraceptinių tablečių vartotojų. 5. Nustatyti sudėtinių kontraceptinių tablečių vartojimo sąsajas su žmogaus papilomos viruso plitimu. 6. Palyginti seksualinės funkcijos pokyčius moterų, vartojančių ketvirtosios kartos sudėtines kontraceptines tabletes, turinčias drospirenono, su barjerinių kontracepcijos priemonių vartotojomis. [...].

OBJECTIVES: The study investigated the effects on female sexual function of a progestogen-containing combined oral contraceptives (COCs) with an antiandrogenic profile taken in a continuous regimen. METHODS: In this prospective randomised single-institution study, 80 healthy women with a monogamous partner and an active sexual life were randomised into two groups for a period of 3 months. Women in the exposed group (n = 40) took a COCs containing 30 μg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) in a 21/7 regimen. Women in the control group (n = 40) used either a barrier contraceptive method (BCM) or a natural family planning method (NFPM). Participants were asked to complete a set of validated questionnaires to assess sociodemographic variables and measure Female Sexual Function Index (FSFI). RESULTS: The total FSFI score (p < 0.0001), as well as the desire (p = 0.04) and arousal (p = 0.03) scores, were significantly lower in the COCs group after 3 months of hormonal contraceptive use compared with baseline. Women using BCM or NFPM showed an improvement in total FSFI score (p = 0.02). Hormonal contraception with DRSP increased the likelihood of worse sexual function in the desire (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.22, 4.98; p = 0.01) and arousal domains (OR 2.85; 95%CI 1.34, 5.93; p = 0.005) and in total FSFI score (OR 2.01; 95%CI 1.45, 2.79; p < 0.001). The results remained statistically significant even after adjustment for smoking status. CONCLUSIONS: The study found evidence that women taking a combined EE/DRSP COCs for 3 months may have a worsening of sexual function as measured by FSFI.

Background. Recently Matulevicius et al (2014) described a women, which had hypersecretion of dehydroepiandrosterone sulphate (DHEAS) and multiple clinical symptoms. Symptoms disappeared after adrenal tumour resection. Such cases were described rarely, being frequently incidental findings. Taking in consideration signs and symptoms of previously described cases, we started to look retrospectively for more cases with high DHEAS and adrenal/ovarian tumours. Aim. To report a clinical case of mixt gonadal dysgenesis with specific karyotype and other abnormalities, not described until now: petrocloval meningioma, labia majora agenesis and idiopathic dehydroepiandrosteronism. Methods. Presentation of clinical case with comments. Results. A woman of 37 years old was presented to a doctor with diagnosed primary amenorrhea and infertility. Physical examination showed Turner syndrome-like clinical characteristics and virilisation. 5 years ago petroclival meningioma was diagnosed. Surgical intervention was postponed. During gynecological examination clitoromegaly was found with absence of labia majora. Perpheral blood lymphocyte culture revealed mosaic karyotype – mos. 45, X [32] / 46, XY [10]. X monosomy was found in 76% of cell clones and 27% of cells had a male karyotype. Blood hormone tests revealed high concentrations of gonadotropins (LH –11.3 U/L, FSH – 29.4 U/L), which confirmed the diagnosis of gonadal dysgenesis –hypergonadotropic hypogonadism. Other hormone levels showed increased levels of DHEAS and testosterone. In order to define the reason of increased DHEAS concentration, low and high dose dexamethasone suppression tests were performed, which revealed incomplete suppression of DHEAS concentration. ACTH stimulation test results were normal. In half an hour DHEAS rhythm test, a variation of gonadotropin was not detected. Imagine tests showed no specific tumors in adrenal glands. [...].

(AR) gene polymorphism. Second, we wanted to determine the link between sexual health changes and combined oral contraceptive (COCP) usage, and third, we aimed to determine the association between sexual function changes and AR gene polymorphism in COCP users. Methods: A randomised case-control study took place during the period from February 2013 to February 2014. The study included 98 healthy 18–40-year-old women with regular menstrual cycles (25–35 days), who were consulted for the usage of contraception. The control group (n¼40) consisted of women, using barrier contraception or natural family planning methods. The study group (n¼58) was composed of women using COCP (ethinylestradiol 0.03 mg/drospirenone 3 mg). The Female Sexual Function Index (FSFI) questionnaire was implemented to evaluate women sexual function. Women were asked to fill out the FSFI in the beginning of the study and after six months. Results: Homozygote women with short-short (SS) alleles were dominant in both groups: 50.7% (n¼30) for the control group and 56.0% (n¼22) for the study group. The average count of homozygote women with long-long (LL) alleles was found to be, respectively, 30.7% (n¼23) and 29.0% (n¼12). The lowest number of heterozygote women with short-long (SL) alleles was discovered in the study population: 18.6% (n¼14) for the study group and 15.0% (n¼6) for the control group. FSFI showed risk for sexual dysfunction (FSFI 26.55) for more than half the patients in the study group (55.2%; n¼32) and for one third of women in the control group (30.0%; n¼12). After evaluating FSFI subscales, it was detected that women in the study group were significantly more likely to experience pain during sexual intercourse if compared to the control group (p¼0.01). Sexual arousal, lubrication, orgasm, satisfaction scores did not differ significantly between the groups respectively (p¼0.6; p¼0.4; p¼0.5; p¼0.3). There was[...].

Objective To investigate the effects of a COCs containing a progestin with anti-androgenic profile (0.03 mg of ethinylestradiol/ 3 mg of drospirenon) in a continuous-regimen on female’s sexual function. Methods In presented prospective, randomized single institution study 80 healthy women with a permanent partner and active sexual life were randomized over two groups according to computer randomize function for 3 cycles. A COC containing 0.03 mg of ethinylestradiol/ 3 mg of drospirenon (EE/DRSP) was administered for the study group (n=40). The control group (n=40) used natural family planning methods and barrier contraception methods (NFPM/BCM). All study participants were asked to fill out a set of validated questionnaires, including the Female Sexual function Index (FSFI) and Dyadic Adjustment Scale (DAS). Results The negative difference (∆) in mean baseline to 3 months changes in sexual function was observed for hormonal contraception method users. COCs was associated with significant reduction in desire, arousal, and total FSFI score compared with non-hormonal contraceptive users (∆=0.30±SD 0.91vs ∆=-0.18±SD 0.58, p=0.01; ∆=0.53±SD 1.45 vs ∆=-0.50±SD 1.06, p=0.002; ∆=9.56±SD 8.39 vs ∆=-0.80±SD 3.96, p<0.001). Hormonal contraception increased the likelihood of worse sexual function in terms of desire (OR 2.47 95% PI 1.22-4.98, p=0.01), arousal (OR 2.85 95% PI 1.34-5.93, p=0.005) and the total FSFI score (OR 2.01 95% CI 1.45-2.79, p<0.001) even after adjusting results for the smoking (desire OR 2.98 95% CI 1.34-6.45, p=0.006; arousal OR 2.74 95% CI 1.28-5.86, p=0.009 and the total FSFI score OR 1.96 95% PI 1.43-2.69, p<0.001). The use of COCs was found to have no impact on couple’s adjustment with adjusting results for smoking. Conclusion The current study found evidence that COCs containing anti-androgenic progestin appeared to be associated with negative effect on female’s sexual functi.