Takayama K, Zeitoun K, Gunby R T, Sasano H, Carr B R, Bulun S E
Cecil H. and Ida Green Center for Reproductive Biology Sciences and Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9051, USA.
Fertil Steril. 1998 Apr;69(4):709-13. doi: 10.1016/s0015-0282(98)00022-3.
To treat an unusually aggressive case of recurrent postmenopausal endometriosis.
Case report.
University of Texas Southwestern Medical Center (Dallas, Texas).
PATIENT(S): A 57-year-old woman who presented with recurrent severe endometriosis after hysterectomy and bilateral salpingo-oophorectomy.
INTERVENTION(S): Oral administration of anastrozole (an aromatase inhibitor) (1 mg/d) and elemental calcium (1.5 g/d) for 9 months. Alendronate (a nonestrogenic inhibitor of bone resorption), 10 mg/d, was added to this regimen.
MAIN OUTCOME MEASURE(S): Reduction in size of endometriotic lesion, pain relief, tissue levels of aromatase P450 messenger RNA, bone density.
RESULT(S): Circulating levels of estradiol-17beta were reduced to approximately 50% of the baseline value after the onset of treatment with anastrozole. Pain rapidly decreased and completely disappeared after the 2nd month of treatment. The 30 x 30 x 20-mm bright red polypoid vaginal lesion was reduced to a 3-mm gray tissue by the end of 9 months of treatment. Markedly high pretreatment levels of aromatase P450 messenger RNA in the endometriotic tissue became undetectable in a specimen obtained from a repeated biopsy after 6 months of treatment. Bone density of lumbar spine decreased by 6.2% after 9 months of treatment.
CONCLUSION(S): This is the first description of the use of an aromatase inhibitor in the treatment of endometriosis. The short-term results were extraordinarily successful in elimination of pain and near-complete eradication of implants associated with severe endometriosis not responsive to other therapy. We conclude that the recently developed potent aromatase inhibitors are candidate drugs in the treatment of endometriosis that is resistant to standard regimens.
治疗一例复发性绝经后子宫内膜异位症的侵袭性异常病例。
病例报告。
德克萨斯大学西南医学中心（德克萨斯州达拉斯）。
一名57岁女性，在子宫切除和双侧输卵管卵巢切除术后出现复发性严重子宫内膜异位症。
口服阿那曲唑（一种芳香化酶抑制剂）（1毫克/天）和元素钙（1.5克/天），持续9个月。在此治疗方案中添加阿仑膦酸钠（一种非雌激素性骨吸收抑制剂），10毫克/天。
子宫内膜异位病灶大小的减小、疼痛缓解、芳香化酶P450信使核糖核酸的组织水平、骨密度。
用阿那曲唑治疗开始后，雌二醇-17β的循环水平降至基线值的约50%。治疗第2个月后疼痛迅速减轻并完全消失。治疗9个月末，30×30×20毫米的鲜红色息肉样阴道病灶缩小为3毫米的灰色组织。治疗6个月后，从重复活检获得的标本中，子宫内膜异位组织中预处理时明显较高的芳香化酶P450信使核糖核酸水平变得无法检测到。治疗9个月后，腰椎骨密度下降了6.2%。
这是首次描述使用芳香化酶抑制剂治疗子宫内膜异位症。短期结果在消除疼痛和几乎完全根除与严重子宫内膜异位症相关的植入物方面非常成功，这些植入物对其他治疗无反应。我们得出结论，最近开发的强效芳香化酶抑制剂是治疗对标准方案耐药的子宫内膜异位症的候选药物。
