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Comment on Menstrual Irregularity in Women with Acromegaly

Institute of Endocrinology Chaim Sheba Medical Center Tel Hashomer, Israel 52621

The report of Kaltsas et al. (1) adds important information regarding menstrual irregularities in 47 women with acromegaly. this common association is not fully recognized. The distinction between a hypoestrogenic form, causing menstrual irregularity due to central gonadotrophic insufficiency (with or without hyperprolactinemia) and an estrogen sufficient form, associated with insulin resistance and a PCOD-like feature, is well described and novel. In reviewing 25 women with acromegaly, but at an older age range, we found an increase in the incidence of uterine leimyomata (2). The proposed mechanism was a direct proliferative effect of GH or insulin-like growth factor I on the myometrium, promoting or maintaining growth (3). This effect can be enhanced by estrogen. Because this phenomena is not well described, it is of interest to have comparative data from other clinics. In the report by Kaltsas et al. (1) they performed ultrasonographic imaging of the ovaries in several patients, but data regarding endometrial thickness or the presence of leiomyomata is not available. Increase in uterine abnormalities can be an additional factor for the menstrual irregularities of women with acromegaly, in particular those with the estrogen-sufficient form. Data on the uterine anatomy of these patients can further clarify the pathogenesis of menstrual irregularity in women with acromegaly.

Footnotes

Address correspondence to: Ohad Cohen, Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel 52621.

Received December 3, 1999.

References

1. Kaltsas GA, Mukherjee JJ, Jenkin PJ, et al. 1999 Menstrual irregularity in women with acromegaly. J Clin Endocrinol Metab. 84:2731–2735.[Abstract/Free Full Text]
2. Cohen O, Schindel B, Homburg R. 1998 Uterine leiomyomata-a feature of acromegaly. Hum Reprod. 13:1945–1946.[Abstract/Free Full Text]
3. Murphy LJ, Gharay AQ. 1990 Uterine insulin-like growth factor I: Irregulation of expression and its role in estrogen induced uterine proliferation. Endocrinol Rev. 11:443–453.[Abstract/Free Full Text]

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