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ERT and pos ERFrom: Terrence.Jones@ncal.kaiperm.orgMon Jun 24 15:37:59 1996
Trying this letter again, not sure if it got thru the last time (too much ether in cyberspace). Anybody have any specific info on est. receptors in neoplasms NOT involving breast/endometrium? Regarding the question of postpartum depression - agree with the TFT's; most cost-effective :( screen is sTSH. Transient thyroiditis, of immunologic origin, may be present in up to 10% of PP Pt.s and frequently presents as depression/fatigue sometimes diff. to distinguish from normal adaptation response. The mechanism involves follicular cell destruction from a lymphocytic infiltrate, modulated by the production of antibodies against microsomes. In an early study (Acta Endocrinol 7/93, vol 129: 26- 30), Pop described the connection between microsomal antibodies and transient postpartum thyroid dysfunction. The study demonstrated only a slight increase in postpartum depression. In a f/u study (J Clin Endo Met 12/95, vol 80: 3561- 6) the nomenclature was refined to TPo-Ab (thyroid peroxidase antibody) and an assoc was made between later IQ scores in children whose mother's had elevations in these antibodies in the puerperium. The lead author -- Pop, was flanked by co-author -- Vader. Maybe I'm gettin' too much Speilberg, but if you put POP and VADER in the same paper I'm gonna' be a tad suspicious of the conclusions ("beware of the dark side"). An article by Parkes (Clin Endo 7/94, 41: 9-14) revealed elevated Thyroglobulin levels in those pt's with antimicrosomal Ab's (TPo-Ab) destined to develop postpartum thyroid dysfunction. Perhaps this may be of some use in distinguishing etiology for dysphoric symptoms, at some point in the future. The Gregoire paper gives some insight on Estrogen supps in the puerperium ("Transdermal Oestrogen for Treatment of Severe Postnatal Depression", Lancet 4/96, vol 347: 930-3). Maybe the recent studies into polyglandular endocrine failure will demonstrate a preponderance of transient ovarian estrogen depletion in those pts with immunologic thyroid dysfunction that develop concomitant depression. In the meantime, it can only help to supplement a hypothyroid state, if detected. tj. --------------------------( Enclosure 1 follows )---------------------------- Date: Wednesday, 19 June 1996 9:10pm PT --------------------------( Enclosure 1 follows )---------------------------- To: ob-gyn-l@listserv.bcm.tmc.edu --------------------------( Enclosure 1 follows )---------------------------- Cc: gyn-docs@oac1.oac.tju.edu From: Terrence.Jones@EMC2NCAL Subject: ERT and pos ER 55yo s/p tah/bso in distant past - no neoplasm associated. Has been on ERT supplements. Developed unusual scalp lesion behind ear - path reveals adenocarcinoma. No primary site has been elicited. The ER (estrogen receptor) analysis is positive. Excisional biopsy was performed with clear margins, all invasive, no in situ component. Won't burden you with ref's, but there appears to be some site-specific patterns to various receptors, and still other ref's that discount any specific receptor-modulated cell growth activity elicited by stimulating these receptors with its assoc hormone (for instance, one study suggests est receptors may have an impact, as yet unrecognized, in upper GI CA, while another suggests these receptors are present in nml mucosa without any physiologic effect). Anybody have any comments on AUP (adenoca of unknown primary), and use of ERT in pts with adenoca unrelated to breast (strictly speaking, not yet proven) or endometrial source; particularly in light of the receptor status?
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