Iatrogenic premature ovarian insufficiency

master's thesis

• Title (croatian): Jatrogena ovarijska insuficijencija
• Author: Lucija Skalicki
• Mentor: Maja Banović (mentor)
• Committee member: Maja Banović (predsjednik povjerenstva)
• Committee member: Vladimir Banović (član povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Premature ovarian insufficiency (POI) is defined as a transient or complete loss of ovarian function before the age of 40. It can occurs as a result of treatment of certain tumors. Premature ovarian insufficiency induced by a medical treatment is referred to as iatrogenic and its incidence is rising mostly due to successful cancer treatments. A chance of ovarian insufficiency depends on type of a drug, dose of a drug or irradiation as well as the patients’ age at the time of the treatment. Damage to the ovaries and POI as a result can be induced by many different mechanisms. Chemotherapy and radiotherapy can cause direct damage to the oocyte DNA or indirect damage via reactive oxygen species (ROS). Alkylating agents are the most harmful chemotherapeutic drugs and are associated with highest incidence of amenorrhea and infertility following chemotherapy. Radiotherapy with doses as low as 2 Gy have been reported to cause POI, therefore many preventive measured such as oophorexy and ovarian shielding have been implemented in younger cancer patients. Surgical procedures can also cause a direct damage of the ovarian tissue, or have an indirect effect through vasculature damage. Clinical effects of ovarian insufficiency are low estrogen levels with many short term and serious long term consequences. For this reason, early diagnosis and immediate management of POI is crucial. Short term effects of estrogen deficiency include vasomotor, urogenital and psychological symptoms. Serious long term consequences include osteoporosis, risk of cardiovascular diseases, neurodegenerative diseases and infertility. Majority of POI patients are advised to take hormone replacement therapy (HRT) to help with short term and long term effects of low estrogen levels. Along with HRT patients are advised to do regular weight bearing exercises and to take vitamin D and calcium supplements daily. Fertility preservation is one of the important issues that these patients have to be advised on.

Abstract (croatian)

Prijevremena ovarijska insuficijencija (POI) definira se kao prijelazni ili potpuni gubitak funkcije jajnika prije dobi od 40 godina. Može se pojaviti spontano ili može biti izazvan različitim čimbenicima. Prijevremena ovarijska insuficijencija kao rezultat liječenja naziva se jaterogenom i njena učestalost raste uglavnom zbog uspješnog liječenja raka. Mogućnost insuficijencije jajnika ovisi o vrsti lijeka, dozi lijeka ili zračenja kao i dobi pacijentice u vrijeme liječenja. Oštećenja jajnika i POI mogu biti uzrokovana različitim mehanizmima. Kemoterapija i radioterapija mogu uzrokovati izravno oštećenje DNK oocita ili neizravno oštećenje putem slobodnih radikala. Alkilirajući citostatici su najštetniji kemoterapijski lijekovi i povezani su s najvećom učestalošću amenoreje i neplodnosti nakon kemoterapije. Zabilježeno je da radioterapija u dozi od 2 Gy uzrokuje POI, stoga su kod mnogih mlađih pacijentica s rakom provedene preventivne mjere poput kirurške transpozicije jajnika izvan polja zračenja i zaštite jajnika štitnikom. Kirurški zahvati također mogu uzrokovati izravno oštećenje tkiva jajnika ili imati neizravan učinak kroz oštećenje vaskulature. Klinički učinci insuficijencije jajnika su niska razina estrogena s mnogim kratkoročnim i ozbiljnim dugoročnim posljedicama. Iz tog razloga, rana dijagnoza i obrada POI pacijenata su od velike važnosti. Kratkoročni učinci nedostatka estrogena uključuju vazomotorne, urogenitalne te psihološke simptome. Ozbiljne dugoročne posljedice uključuju osteoporozu, rizik od kardiovaskularnih bolesti, neurodegenerativne bolesti i neplodnost. Većini bolesnica kojima je dijagnosticirani POI preporučuje se hormonska nadomjesna terapija (HRT) kako bi se pomoglo u kratkoročnim i dugoročnim učincima niskih razina estrogena. Zajedno s HRT-om, pacijentima se preporučuje redovito vježbanje s utezima i svakodnevno uzimanje dodataka vitamina D i kalcija. Očuvanje plodnosti jedna je od važnih tema o kojoj je potrebno savjetovati ove pacijentice.

• Keywords: iatrogenic; POI; estrogen deficiency; infertility
• Keywords (croatian): jatrogeni; POI; nedostatak estrogena; neplodnost
• Language: english
• URN:NBN: urn:nbn:hr:105:223002
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-10-08 09:41:58