GnRH analogue may be given in all of the following except
Ans. is b i.e Endometrial Ca GnRH agonist : Mechanism of action : GnRH agonist bind to GnRH receptors in the pituitary, and cause competitive inhibition of endogenous GnRH. Initially there is a supraphysiological release of FSH and LH from pituitary (Flare) followed by decrease in the synthesis and release of both FSH and LH. Preparations of GnRH : * Buserelin * Leuprorelin Nafarelin * Gosserelin Triptorelin * Historelin Method of administration : Subcutaneous/intramuscular injections or as nasal sprays. Indications : In females : (In all those conditions where there is increased estrogen, GnRH analogues are useful). Mnemonic : A - F and HIP. A = Adenomyosis B = Irritable Bowel Syndrome (under Trial) C = Ca Breast (Tamoxifen + GnRH agonist give good result) D = DUB E = Endometriosis F = Fibromyoma uterus. H = Hirsutism I = Infeility P = Precocious Pubey. In males : Cryptorchidism : sho term intranasal nafarelin is used. Carcinoma prostrate : GnRH agonist are as effective as orchidectomy in Ca prostrate but if there are neurological symptoms or life threatening metastatic disease - androgens should first be staed followed by GnRH agonist. BPH : Daily administration of leuprorelin or nafarelin decreases obstructive urinary symptoms in 1-6 months time. Adverse effects of GnRH : Local allergic reaction may occur at injection site. They cause menopause like Symptoms -- Hot flushes, vaginal dryness, headache, joint and muscle stiffness, depression, osteoporosis and irregular vaginal bleeding. GnRH antagonist : Acts immediately to stop Gonadotropin secretion (without any flare) eg : Cetrirelix, Ganirelix, Nal-glu. They have been superceeded by GnRH agonist in clinical practice except for their potential role in Contraception. Nal-glu given for 3 weeks inhibits spermatogenesis
Prostate Ca
Endometrium Ca
Fibromyoma - uterus
Precocious pubey