İzotretinoinin Serum Hormonları ve Menstrüel Siklus Üzerine Etkileri

Yıl 2018, Cilt: 51 Sayı: 2, 145 - 149, 29.08.2018

Fidan Bener

Öz

Amaç: Akne vulgaris tanısıyla izotretinoin tedavisi
kullanan kadın hastaların serum hormon ve menstrüel sikluslarında ortaya çıkan
değişikliklerin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Retrospektif olarak yapılan bu çalışmada, akne
vulgaris nedeniyle izotretinoin tedavisi başlanmış, tedavi öncesi düzenli
menstrüel sikluslara sahip, laboratuvar parametreleri normal sınırlarda olan,
herhangi bir sistemik hastalığı bulunmayan ve başka ilaç kullanmayan kadın
hastaların verileri incelenmiştir.

Bulgular: Çalışmaya dahil edilen 21 hastanın yaş ortalaması
22±3.87 idi. Hastalara uygulanan izotretinoin kümülatif dozu 123.90±4.71 mg/kg
idi. Tedavi sırasında hastaların %19.1’inde dehidroepiandrosteron sülfat
(DHEAS), %23.8’inde serbest testosteron (sT), %33.3’ünde total testosteron (tT)
serum seviyelerinin referans aralığının üzerine çıktığı tespit edildi. Ortalama
DHEAS ve sT düzeylerinde tedavi öncesine kıyasla istatistiksel olarak anlamlı
olmayan artış saptandı (p>0.05). Tedavi boyunca normal sınırlar arasında
ortalama tiroid stimüle edici hormon (TSH) değerlerinde istatistiksel olarak
anlamlı (p<0.05) ve ortalama serbest T3 (sT3) düzeylerinde anlamlı olmayan (p>0.05)
progresif azalma tespit edildi. Prolaktin, 17-hidroksiprogesteron, tT, folikül
stimüle edici hormon, lüteinize edici hormon ve serbest T4 ortalama
değerlerinde anlamlı bir fark bulunmadı (p>0.05). Hastaların %23.8'inde
menstrüel düzensizlik olduğu saptandı. Bir hastada polimenore, bir hastada
hipomenore, üç hastada oligomenore ve oligomenore gelişen hastaların birinde de
siklus ortası kanama ortaya çıktığı tespit edildi. Menstrüel düzensizlik
gelişen hastaların hormon değerlerinde herhangi bir değişiklik olmadığı
belirlendi.

Sonuç: Bu çalışma izotretinoinin androjen metaboliması,
tiroid hormonları ve menstrüel sikluslar üzerinde etkili olduğunu
göstermektedir. Bu nedenle uzun süreli tedavilerde hiperandrojenizm ve
hipotiroidi açısından takip önerilmektedir. Anormal uterin kanamaların hormonal
kaynaklı olmadığı düşünülmektedir. Bu etkilerin hangi mekanizmalarla ortaya
çıktığının kanıtlanabilmesi için ileri seviyede araştırmalara gerek vardır.

Anahtar Kelimeler

Akne vulgaris, izotretinoin, serum hormonları, menstrüel siklus

The Effects of Isotretinoin on Menstrual Cycle and Hormone Levels

Öz

Introductıon: This study aimed at
examining the effects of isotretinoin treatment on menstrual cycle and serum
hormones in women with acne vulgaris.

Materials and methods: In this retrospective study, the data of female
patients who have been treated with isotretinoin for acne vulgaris, had regular
menstrual cycles before treatment, had normal laboratory parameters, had no any
systemic disease and did not take any medicine have been examined.

Results: The mean age of the 21 women included in the study was 22±3.87. The
cumulative dose of isotretinoin administered to the patient was 123.90±4.71
mg/kg. During the treatment, in 19.1% of the patients dehydroepiandrosterone
sulfate (DHEAS), in 23.8% of free testosterone (fT) and in
33.3% of total testosterone (tT) were reported to be higher than the reference
range of serum levels. There was a statistically insignificant increase in mean
DHEAS and fT levels (p>0.05) compared to before treatment. During the
treatment, a statistically significant in mean thyroid stimulating hormone
(TSH) values (p<0.05) and a insignificant in mean free T3 (fT3) values
(p>0.05) was determined progressive decrease between normal limits. There
was no significant difference in mean values of 17-hydroxyprogesterone, tT,
prolactin, follicle stimulating hormone, luteinizing hormone and free T4
(p>0.05). We found that 23.8% of the patients had menstrual irregularity. In
one patient polymenorrhea was observed and hypomenorrhea in another one. Also,
oligomenorrhea was observed in three patient, with one of them hemorrhage in
the middle of her cycle. It has been determined that there is no change in the
hormone levels of patients with menstrual irregularity.

Conclusion: In this study show that isotretinoin has an effect
on androgen metabolism, on thyroid hormones and on menstrual cycles. For this
reason, we recommend follow-up in terms of hyperandrogenism and hypothyroidism
in long-term treatment. As a result of the data, it can be said that abnormal
uterine bleeding is not hormonal origin. Further studies are needed to prove
what kind of mechanism cause these effects.

Anahtar Kelimeler

Acne vulgaris, isotretinoin, serum hormones, menstrual cycle

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