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Reproductive system

Gynecomastia is frequent in men with testicular tumors that produce large amounts of human chorionic gona-dotrophin (HCG), and its appearance after completion of chemotherapy may indicate residual or recurrent disease. However, not uncommonly, gynecomastia is a harmless, although troubling, late adverse effect of chemotherapy. In 16 patients who developed gynecomastia 2-9 months after treatment, and who were in complete remission, estradiol concentrations were raised follicle-stimulating hormone (FSH) produced a higher estradiol testosterone ratio than similarly treated patients without gynecomastia (61). It is likely that this was due to increased secretion of testicular estrogen in response to a compensatory increase in pituitary gonadotrophins after cytostatic damage to Leydig cells and spermatogenesis.

Aldosterone antagonists

Spironolactone is the most important representative of the aldosterone antagonists, in which the diuretic action depends on the inhibition of receptors for aldosterone and other mineral corticoids in the tubule cells. An antiandrogen action is also recognized, which can be used in women who suffer from hirsutism and in boys who have pubertas praecox. For men, treatment with spironolactone can cause gynecomastia.

General adverse effects

Salt and water retention due to estrogens can cause weight gain and a rise in blood pressure. Changes in liver function tests can occur and jaundice is sometimes seen. Mild gastrointestinal upsets are not unusual. Unwanted endocrine effects include uncomfortable stimulation of the breasts and endometrial bleeding. In men, estrogens produce gynecomastia. Hypersensitivity reactions are rare and include urticaria, edema, and bronchospasm. Men taking estrogens generally do so in the course of palliative treatment for malignancies (prostatic carcinoma), for which high doses have sometimes been used. Estrogen therapy in men with prostate cancer may be superior to castration in terms of efficacy, but orally administered estrogens are associated with adverse effects gynecomastia, loss of sexual function, and unacceptable cardiovascular toxicity (9). Low-dose estrogens in combination with anti-androgens or antithrombotic agents may be better tolerated.

Exogenous and Endogenous Cannabinoids and Their Role in Endocrine Regulation

It has been known for a long time that exogenous canna-binoids are able to affect secretion of pituitary hormones, thus having a strong effect on peripheral target organ functions. Notably, in 1972 the first report of an induction of gynecomastia due to marijuana consumption led to a dramatic acceleration of studies on this topic (134). The hypothalamus is generally considered as the main site of canna-binoid action on neuroendocrine functions. This view is elegantly supported by a recent publication showing that endocannabinoids act as retrograde messengers activating CB1 receptors expressed at presynaptic glutamatergic ter

Potassium Sparing Diuretics

Hyperkalemia (increase in potassium in the blood), a serious event, may be seen with the administration of potassium-sparing diuretics. Hyperkalemia is most likely to occur in patients with an inadequate fluid intake and urine output, those with diabetes or renal disease, the elderly, and those who are severely ill. In patients taking spironolactone, gynecomastia (breast enlargement in the male) may occur. This reaction appears to be related to both dosage and duration of therapy. The gynecomastia is usually reversible when therapy is discontinued, but in rare instances, some breast enlargement may remain.

Second Generation Effects Fertility

The effects of combined oral contraceptives on lactation have been examined carefully (291,292), since estrogens are well-known inhibitors of ovulation in large doses. Even products containing 30 micrograms of ethinyl-estradiol reduce the volume of milk (293) the composition of the milk is also slightly altered, but again one has the impression that the effect is not important, except in a very poorly nourished population. Both progestogens and estrogens are excreted in the milk, their proportions correlating with those in plasma, but the absolute concentrations are lower. The plasma milk ratio varies from compound to compound, probably owing to variations in the degree of protein binding and (for progestogens) also to the variable amount of fat in the milk. The amount of steroid transferred in 600 ml of milk is estimated at 0.1 or less of the daily dose taken. Although newborn infants might be relatively sensitive to these hormonal substances, because of the immaturity of their...

Review of Endocrine Function

One long held claim is the production of gynecomastia in males associated with cannabis use. A case study or 3 cannabis smokers with this malady was reported by Harmon and Aliapoulios (1972). A more thorough investigation a few years later failed to show any differences in cannabis use in affected males between users and controls (Cates and Pope 1977). The latter statement would seem to be borne out by our findings. While one male subject had a minor degree of gynecomastia associated with obesity, none of the Patients A-D displayed any abnormal values in any endocrine measure (Table 5).

Congestive Heart Failure

Typical adverse effects are hyperkalemia and gynecomastia (with spironolactone). Again, combinations with potassium supplements or ACE inhibitors may lead to serious hyperkalemia. Cardiovascular effects include any form of cardiac arrhythmia especially ventricular bigeminy and bradycardias and complete heart block. Electrocardiogram may show first-degree heart block at an early stage, although serious arrhythmias may occur without prior warning. Gynecomastia is also another unpleasant side effect. Contraindications associated with digitalis compounds include

Long Term Effects Tumorigenicity

Spironolactone is antiandrogenic and increases the peripheral metabolism of testosterone to estradiol (13). It often causes gynecomastia in men and breast enlargement and soreness in women. Five cases of mammary carcinoma have been reported. Potential human metabolic products of spironolactone are carcinogenic in rodents, and the UK Committee on Safety of Medicines in 1988 restricted the approved indications for the drug, removing the indications of essential hypertension and idiopathic edema (14).

Reproduction system hormone system and the fetus

Many investigations suggest that marijuana has adverse effects on the reproduction system and may be harmful to the fetus (Nahas and Latour, 1992 Witorsch et al., 1995). By necessity, most studies on the reproductive system have been done in animals, however, human data has been collected as well. For example, marijuana appears to alter the menstrual cycle and decrease ovulation (Ashton, 1999 Nahas and Latour, 1992 Witorsch et al., 1995). This may be due to effects of cannabinoids on sex hormones (Witorsch et al., 1995). While acute marijuana exposure tends to decrease prolactin levels, chronic use may increase prolactin and lead to gynecomastia in males and galactorrhea in females (Ashton, 1999). Duration of labor may also be affected by marijuana use (Gold, 1994 Martin and Hubbard,

Medical And Behavioral Toxicity Overview

Alcoholic liver disease may also produce femi-nization in men, as a result of impaired metabolism (breakdown) of female sex hormones such as estrogen. Signs of such feminization in men include gynecomastia (enlarged breasts) and female fat distribution. In women who drink alcohol excessively, there is a high prevalence of gynecologic disorders (missed periods and problems in functioning of ovaries) and a possibly earlier onset of menopause than in nondrinkers. In women alcohol is metabolized at different rates according to the particular phase of the menstrual cycle. Other hormonal effects have been described in association with acute alcohol ingestion, including the impaired release of growth hormone and increased release of prolactin, a hormone involved in milk production. Thyroid function, which controls the body's rate of metabolism, can be indirectly affected as a result of alcoholic liver disease. This effect occurs from impaired conversion of T4 (a form of thyroid hormone) to...

General Information

Non-specific, usually reversible, cardiographic changes have been reported, but their relation to myocardial toxicity has not been confirmed. Sudden death related to cardiac arrest cannot be fully explained on the basis of the administration of neuroleptic drugs. Weight gain is a common adverse effect. Breast engorgement and galac-torrhea can occur in women and even in men. Amenorrhea, gynecomastia, hyperglycemia, hypoglycemia, raised growth hormone, inappropriate ADH secretion, and disturbance of sex hormones have been reliably documented, although they are unusual.

General adverse reactions

Male hormone replacement therapy has been reviewed (11). Hypogonadism can be accompanied by hot flushes, similar to those seen in postmenopausal women, and gyne-comastia. The potential risks of testosterone replacement in adult men are precipitation or worsening of sleep apnea, hastened onset of clinical significant prostate disease, benign prostatic hyperplasia, prostatic carcinoma, gynecomastia, fluid retention, polycythemia, exacerbation of hypertension, edema, and an increased risk of cardiovascular disease.

Overall level of evidence of adverse effects D

931 Boccardo F, Rubagotti A, Battaglia M, Tonno P di, Selvaggi FP, Conti G, Comeri G, Bertaccini A, Martorana G, Galassi P, Zattoni F, Macchiarella A, Siragusa A, Muscas G, Durand F, Potenzoni D, Manganelli A, Ferraris V, Montefiore F. Evaluation of tamoxifen and anastrozole in the prevention of gynecomastia and breast pain induced by bicalutamide monotherapy of prostate cancer. J Clin Oncol. 2005 Feb 1 23(4) 808-15. English 930 Saltzstein D, Sieber P, Morris T, Gallo J. Prevention and management of bicalutamide-induced gynecomastia and breast pain randomized endocrinologic and clinical studies with tamoxifen and anastrozole. Prostate Cancer Prostatic Dis. 2005 8(1) 75-83. English

Other Effects

TCA's can cause gynecomastia and amenorrhea in some patients, while SSRIs can cause increased prolactin levels causing mammoplasia and galactorrhea in both men and women. SSRIs have also been known to reduce blood glucose levels, though this is rare. Nefazodone has been associated with rare cases of life-threatening liver failure, and has been removed from the market in many European countries. As a result, nefazodone should not normally be considered for use before other antidepressants.

Estrogen Therapy

However, toxicities with this treatment are common, with dose-related adverse reactions including arterial and venous thrombosis, nausea, and fluid retention. Furthermore, impotence and gynecomastia always occur in men, and withdrawal bleeding can be a problem in women. Estrogen may also cause bone pain and hypercalcemia when used to treat breast cancer. Ethinylestradiol, also used to treat breast cancer, is the most potent estrogen available for this purpose.

Tenofovir

Reproductive system Gynecomastia and breast hypertrophy have been reported in at least three patients. All had had indinavir replaced by efavirenz. No other medications were changed, and gynecomastia was not present before substitution (31A). The breast enlargement was generally asymmetrical and painful. Needle biopsy was consistent with gynecomastia. Six other reports have confirmed painful breast hypertrophy in patients taking efavirenz (32A).

Antiandrogens

Androgen antagonists37 bind to the receptor and prevent binding of the natural steroids, but they do not produce the correct conformational change in the receptor that is essential to elicit normal changes in gene expression. Cyproterone is a steroidal antiandrogen that was initially developed as a synthetic gestagen to be used as a contraceptive, but the observation of feminization of the offspring in gestating rats led to its identification as a competitive inhibitor of the AR. It is used in prostatic carcinoma, but its side effects of gynecomastia and edema, which can be attributed to its analogy with natural gestagens and glucocorticoids, respectively, stimulated the search for nonsteroidal compounds with pure antiandrogenic action (SARM, selective androgen receptor modulators).

Gum opium Opium

To drink greedily or habitually. 2. To consume to excess. Guaibasim Psidium guajava. Guantug Brugmansia sanguinea. Guevelina Properidine. Gynecomastia Abnormal enlargement of the breasts in a male, side effect of using anabolic steroids. The excessive growth of the male mammary glands in some cases include development to the stage where milk is produced.

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