Benjamin I, Block R E
Obstet Gynecol. 1977 Aug;50(2):136-8.
A study was made of the endometria of 16 patients with gonadal dysgenesis who had been give cyclic replacement treatment with conjugated estrogens for 2 to 10 years, and of 9 other patients who had received medroxyprogesterone in addition to the conjugated estrogens for 2 to 5 years. Seven of the former group showed varying degrees of endometrial hyperplasia, and in all of these cases the duration of estrogen therapy had exceeded 5 years. At the time of the study no cases had developed frank adenocarcinoma. Only 1 of the 9 patients who had been given medroxyprogesterone in addition to the conjugated estrogens demonstrated evidence of hyperplastic change. Progesterone may afford some protection against the development of endometrial hyperplastic activity, but its potential role in protecting against neoplasia remains to be determined. This study supports the view that estrogen replacement therapy in gonadal dysgenesis carries the risk of endometrial hyperplasia and neoplasia. Possible methods of decreasing this hazard are discussed.
对16例性腺发育不全患者的子宫内膜进行了研究，这些患者接受结合雌激素的周期性替代治疗2至10年；还对另外9例患者进行了研究，这些患者在接受结合雌激素治疗的基础上，加用甲羟孕酮治疗2至5年。前一组中有7例表现出不同程度的子宫内膜增生，在所有这些病例中，雌激素治疗的持续时间超过了5年。在研究时，没有病例发展为明显的腺癌。在9例接受结合雌激素加用甲羟孕酮治疗的患者中，只有1例有增生性改变的证据。孕酮可能对子宫内膜增生活动的发展有一定的保护作用，但其在预防肿瘤形成方面的潜在作用仍有待确定。这项研究支持这样一种观点，即性腺发育不全患者的雌激素替代疗法存在子宫内膜增生和肿瘤形成的风险。文中讨论了降低这种风险的可能方法。
