Adrenal Regulation of Mammary Tumorigenesis in Female Sprague-Dawley Rats: Incidence, Latency, and Yield of Mammary Tumors1

Total Page:16

File Type:pdf, Size:1020Kb

Adrenal Regulation of Mammary Tumorigenesis in Female Sprague-Dawley Rats: Incidence, Latency, and Yield of Mammary Tumors1 (CANCER RESEARCH 48, 3801-3807, July 1, 1988] Adrenal Regulation of Mammary Tumorigenesis in Female Sprague-Dawley Rats: Incidence, Latency, and Yield of Mammary Tumors1 Julia H. Carter,2 Harry W. Carter, and James Meade Wood Hudson Cancer Research Laboratory, Covington, Kentucky 41011 [J. H. C., H. W. C.J, and Department of Laboratory Medicine, St. Elitabeth Medical Center, Covington and Edgewood, Kentucky 41015 [H. W. C.J ABSTRACT interest to know if these regenerated adrenals were also resistant to a second dose of DMBA. Secondly, Jensen et al. (5) dem Huggins and Morii (J. Exp. Mod., 114: 741, 1961) reported that onstrated that 4 h after exposure to DMBA, incorporation of massive adrenal necrosis occurs in 79 and 100% of female Sprague- [3H]thymidine by adrenals was reduced 56%, suggesting that Dawley rats receiving 20 and 30 mg, respectively, of the mammary carcinogen 7,12-dimethylbenz(a)anthracene (DMBA). Here, adrenal ne inhibition of DNA synthesis was a very early manifestation of crosis and regeneration were studied in 158 rats for up to 21 days post- DMBA-induced damage in the adrenal. Pretreatment of ani DMBA by radioautography of the adrenals of animals given 50 ¿iCi mals with drugs that protect adrenals from DMBA-induced [3H]thymidine 30 min before sacrifice. Adrenal cell proliferation was damage prevented inhibition of [3H]thymidine incorporation markedly inhibited 21 days post-DMBA. Regenerated adrenals were into the acid-insoluble fraction of adrenals from DMBA-treated more susceptible to this adrenocorticolytic effect. To investigate if alter rats (6). Although DNA synthesis in adrenals was inhibited 4- ations in adrenal function modify tumorigenesis, animals underwent ad- 20 h after DMBA, it was not known in what cell type or in renalectomies (ADX), hypophysectomies, ovariectomies, and pituitary what zone of the adrenal DNA synthesis was inhibited, nor transplants alone or in combination 6 days after receiving DMBA (20 were later stages of necrosis and regeneration examined. mg/100 g intragastrically) at 50 days of age. To prevent adrenal necrosis, The purpose of these studies initially was to determine if 24 animals were pretreated with metyrapone. Methylprednisolone ace there are persistent long-term abnormalities in adrenal physi tate, 1 mg ¡.m.,was given to 40 animals every 5 days beginning 6 days post-DMBA. There were 50 non-DMBA-treated intact and surgical ology in female Sprague-Dawley rats given carcinogenic doses controls. DMBA was necessary but not sufficient to induce mammary of DMBA. To accomplish this, adrenal parenchymal and inter tumors. No tumors developed in controls or in 46 animals hypophysec- stitial cell proliferation was studied 2-21 days after DMBA in tomized 6 days after DMBA. Metyrapone reduced tumor incidence and the 3 zones of the adrenal cortex by quantitation of cell labeling yield. ADX after DMBA treatment increased the tumorigenic response by radioautography of adrenals from animals given [3H]thymi- and eliminated resistance to tumorigenesis in older rats. Only three dine. Rather than sacrifice all animals, we removed adrenals tumors developed in DMBA-treated rats receiving methylprednisolone surgically for radioautographic studies. To our surprise, breast acetate. Mammary tumorigenesis was increased by pituitary transplant tumors appeared early and grew rapidly in the adrenalectomized 6 days after DMBA to intact and ADX animals. Ovariectomy 6 days survivors, prompting us to investigate further the role of the after DMBA was as effective as methylprednisolone acetate in preventing adrenal and DMBA-induced adrenal necrosis in mammary tumorigenesis; ADX did not overcome either inhibition. We conclude that adrenal hormones inhibit proliferation of initiated mammary cells. carcinogenesis initiated by this drug. The purpose of the ensuing carcinogenesis studies was to evaluate the role of alterations in adrenal function and corti- INTRODUCTION costeroid level after exposure to an initiating dose of DMBA The following experiments began as an inquiry into the extent upon tumor incidence, latency, and yield. While the effect of of adrenal regeneration following DMBAMnduced necrosis in hormones, such as prolactin, on the growth characteristics of Sprague-Dawley rats. Huggins and Morii (1) demonstrated that established DMBA-induced mammary tumors has been well adrenal apoplexy occurred 3 days following p.o. administration characterized (7), the role of hormones on the expansion of the of DMBA to 50-day-old female Sprague-Dawley rats. The population of initiated cells to nodules has been neglected. dosage causing death to one-half of the rats was 27 mg/ml. The optimum dose for induction of adrenal necrosis was 30 mg (18 MATERIALS AND METHODS mg/lût)g body weight). At this dosage all animals survived and developed adrenal hemorrhage and necrosis, while at the lower Animals and Carcinogen. Female Sprague-Dawley CD rats were dose of 20 mg (12 mg/100 g body weight), which had previously obtained from Charles River Breeding Laboratories, Wilmington, MA. been shown to be carcinogenic (2), 79% of the animals devel DMBA (Eastman Organic Chemicals, Rochester, NY) was dissolved in oped adrenal necrosis. Interestingly, the extent of DMBA- sesame oil (20 mg/ml) by gentle warming and 1 ml/100 g body weight induced hemorrhage and necrosis was considerably less in ad was administered i.g. (No. 9 French catheter) to animals that had been deprived of food but not water for 5 h. The average total dose of DMBA renal glands which had regenerated after enucleation (1). Since for 50-day-old rats was 32 mg. Animals were given 0.9% saline con DMBA-induced adrenal necrosis is followed by adrenal regen taining 6% glucose to drink for 6 days after DMBA treatment to eration beginning 6 or 7 days post-DMBA (1,3, 4), it was of compensate for toxic effects of drug (decreased food consumption and Received 11/3/87; revised 3/21/88; accepted 4/6/88. adrenal necrosis). The costs of publication of this article were defrayed in part by the payment Radiological Studies of Adrenal Regeneration. To quantify cellular of page charges. This article must therefore be hereby marked advertisement in proliferation in the adrenal, 50 animals were given DMBA (20 mg/100 accordance with 18 U.S.C. Section 1734 solely to indicate this fact. 1Major portions of this work were performed at the Cancer Research Institute g body weight) at 50 days of age. At intervals of 2, 3, 4, 6, 8, 14, and of the New England Deaconess Hospital, Boston, MA, and were supported by 21 days after DMBA, an average of 6 animals per group were given 50 the Atomic Energy Commission [Contracts AT (30-l)-3777 and AT (30-1)- fiCi [3H]thymidine (Schwarz Laboratories, Inc., Mt. Vernon, NY) s.c. 3779]. and were adrenalectomized 30 min later. Eighteen control animals 2To whom requests for reprints should be addressed, at Wood Hudson Cancer received [3H]thymidine at 50 or 60 days of age but no DMBA. Research Laboratory, 1830 Greenup Street, Covington, KY 41011. Adrenals from animals given [3Hjthymidine were fixed for 24 h in 3The abbreviations used are: DMBA, 7,12-dimethylbenz(a)anthracene; i.g., intragastrically; ADX, adrenalectomy; PitX, hypophysectomy; OVX, ovariec- neutral 10% formalin. After embedding in paraffin, 5 sections were cut tomy; l'i! Ir, pituitary transplant. from each pair of adrenals at 5 ^m and mounted on 5 slides. Slides 3801 Downloaded from cancerres.aacrjournals.org on September 26, 2021. © 1988 American Association for Cancer Research. ADRENAL REGULATION OF MAMMARY TUMORIGENESIS were deparaffinized, rehydrated, and dipped in NTB2 emulsion (East receive DMBA but which either were adrenalectomized or received a man Kodak Co., Rochester, NY). Emulsion-coated slides were exposed pituitary transplant. Animals in other surgical treatment groups re for 4 weeks in the Con-Rad/Joftes fluid emulsion autoradiography ceived DMBA at 50 or 70 days of age and underwent surgery 6 days system in a CO: atmosphere and a relative humidity below 15%. They thereafter. Surgery was performed under ether anesthesia and animals were developed using Kodak 19 developer (3 min), Kodak SBSa stop received 2.5 mg of hydrocortisone acetate s.c. and 200,000 units of bath (15 s), and Kodak acid fixer (twice clearing time). Solutions were penicillin i.p. postoperatively. Surgical procedures included ADX, PitX, maintained at 18°Cthroughout development. Developed slides were OVX, and PitTr, alone or in combinations of two procedures. Hypo- washed for 12 to 18 h, stained with hematoxylin and eosin, dehydrated, physectomy was by the parapharyngeal route. Pituitary transplant and mounted in balsam. animals received a single pituitary from a 56-day-old donor which was The thymidine-labeling index was measured by counting 2500 cells transplanted to the subcapsular space of the left kidney. per zone of each adrenal of each rat (i.e., 500 cells per zone in each of Observation of Animals. All animals were housed at 26.5°Cand given 5 tissue sections) and was expressed as the mean number of labeled 0.9% saline ad libitum as these conditions were required for survival of cells per 100 x 100%. Cells which showed 5 or more silver granules adrenalectomized animals. Animals were palpated twice weekly begin over the nucleus were considered to be labeled and in S phase. Only ning 4 weeks post-DMBA. When an animal developed numerous viable cells away from necrotic areas were counted. The number of nodules, or large, life-threatening nodules, it was killed. Animals in labeled interstitial and parenchyma! cells was recorded. S phase is some groups were killed as early as 65 days (see Table 1). Remaining considered a more accurate assessment of regeneration than mitotic animals in tumor-bearing groups were sacrificed by 150 days. Hypophy- index. sectomized animals were maintained for up to 200 days.
Recommended publications
  • Systemic Effect of Inhaled Corticosteroids on Adrenal
    Issa-El-Khoury et al. Allergy, Asthma & Clinical Immunology (2015) 11:9 DOI 10.1186/s13223-015-0075-z ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY POSITION ARTICLE AND GUIDELINES Open Access CSACI position statement: systemic effect of inhaled corticosteroids on adrenal suppression in the management of pediatric asthma Karine Issa-El-Khoury1, Harold Kim2,3, Edmond S Chan4, Tim Vander Leek5 and Francisco Noya1* Abstract Asthma is a chronic inflammatory disease of the airways that affects a growing number of children and adolescents. Inhaled corticosteroids (ICS) are the mainstay of treatment in persistent asthma, with a stepwise approach to increasing doses of ICS depending on asthma severity and control. ICS have known local and systemic side effects, of which adrenal suppression is still under-recognized. The latter is associated with chronic exposure and higher doses, although it has rarely been reported in children receiving low doses for a short period of time. The Canadian Society of Allergy and Clinical Immunology (CSACI) therefore recommends that physicians screen for adrenal suppression in children receiving high doses for more than 6 months and to consider screening those on medium dose if the risk is deemed higher by factors that increase an individual’s systemic corticosteroid exposure. Morning serum cortisol level can be used as a screening tool and abnormal results or normal results with a high index of suspicion should be confirmed with low-dose ACTH stimulation tests. Keywords: Asthma, Inhaled corticosteroids, Fluticasone, Adrenal suppression Background reducing asthma mortality. Most patients can achieve Asthma affects about 10% of the Canadian population, and asthma control using relatively low doses of ICS, which 50-80% of children affected develop it before the age of 5 will produce maximum or near-maximum clinical benefit, years [1].
    [Show full text]
  • Auspar Attachment 1: Product Information for Progesterone
    Attachment 1: Product information for AusPAR - ORIPRO - Progesterone - Orion Laboratories Ltd (T/A Perrigo Australia) - PM-2018-04477-1-5 FINAL 7 February 2020. This is the Product Information that was approved with the submission described in this AusPAR. It may have been superseded. For the most recent PI, please refer to the TGA website at <https://www.tga.gov.au/product-information-pi> AUSTRALIAN PRODUCT INFORMATION – ORIPRO® (PROGESTERONE) PESSARIES 1 NAME OF THE MEDICINE Progesterone 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Oripro Pessaries contain as active substance 100mg or 200mg of progesterone (micronized) in hard fat. 3 PHARMACEUTICAL FORM Vaginal Pessaries - Opaque, bullet-shaped waxy, solid masses. 4 CLINICAL PARTICULARS 4.1 THERAPEUTIC INDICATIONS Oripro Pessaries are indicated for: 1. Assisted reproductive technology (ART) treatment of infertile women with progesterone deficiency, requiring progesterone supplementation or replacement to support embryo implantation and maintain initial pregnancy. 2. Prevention of preterm birth in singleton pregnancies at risk due to; · Shortened cervix 1 Attachment 1: Product information for AusPAR - ORIPRO - Progesterone - Orion Laboratories Ltd (T/A Perrigo Australia) - PM-2018-04477-1-5 FINAL 7 February 2020. This is the Product Information that was approved with the submission described in this AusPAR. It may have been superseded. For the most recent PI, please refer to the TGA website at <https://www.tga.gov.au/product-information-pi> The dosage of progesterone for prevention of preterm birth is 200 mg daily (at night). Treatment can be initiated during the second trimester (16-24 weeks gestation) and is to be continued to the end of the 36th week of gestation or until delivery.
    [Show full text]
  • Pharmacology/Therapeutics II Block III Lectures 2013-14
    Pharmacology/Therapeutics II Block III Lectures 2013‐14 66. Hypothalamic/pituitary Hormones ‐ Rana 67. Estrogens and Progesterone I ‐ Rana 68. Estrogens and Progesterone II ‐ Rana 69. Androgens ‐ Rana 70. Thyroid/Anti‐Thyroid Drugs – Patel 71. Calcium Metabolism – Patel 72. Adrenocorticosterioids and Antagonists – Clipstone 73. Diabetes Drugs I – Clipstone 74. Diabetes Drugs II ‐ Clipstone Pharmacology & Therapeutics Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones, March 20, 2014 Lecture Ajay Rana, Ph.D. Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones Date: Thursday, March 20, 2014-8:30 AM Reading Assignment: Katzung, Chapter 37 Key Concepts and Learning Objectives To review the physiology of neuroendocrine regulation To discuss the use neuroendocrine agents for the treatment of representative neuroendocrine disorders: growth hormone deficiency/excess, infertility, hyperprolactinemia Drugs discussed Growth Hormone Deficiency: . Recombinant hGH . Synthetic GHRH, Recombinant IGF-1 Growth Hormone Excess: . Somatostatin analogue . GH receptor antagonist . Dopamine receptor agonist Infertility and other endocrine related disorders: . Human menopausal and recombinant gonadotropins . GnRH agonists as activators . GnRH agonists as inhibitors . GnRH receptor antagonists Hyperprolactinemia: . Dopamine receptor agonists 1 Pharmacology & Therapeutics Neuroendocrine Pharmacology: Hypothalamic and Pituitary Hormones, March 20, 2014 Lecture Ajay Rana, Ph.D. 1. Overview of Neuroendocrine Systems The neuroendocrine
    [Show full text]
  • Mifepristone (Korlym)
    Drug and Biologic Coverage Policy Effective Date ............................................ 1/1/2021 Next Review Date… ..................................... 1/1/2022 Coverage Policy Number ............................... IP0092 Mifepristone (Korlym®) Table of Contents Related Coverage Resources Overview .............................................................. 1 Coverage Policy ................................................... 1 Reauthorization Criteria ....................................... 2 Authorization Duration ......................................... 2 Conditions Not Covered....................................... 2 Background .......................................................... 3 References .......................................................... 4 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage
    [Show full text]
  • Metyrapone-Responsive Ectopic ACTH-Secreting Pheochromocytoma with a Vicious Cycle Via a Glucocorticoid-Driven Positive-Feedback Mechanism
    2018, 65 (7), 755-767 Original Metyrapone-responsive ectopic ACTH-secreting pheochromocytoma with a vicious cycle via a glucocorticoid-driven positive-feedback mechanism Minako Inoue1), Ken Okamura1), Chie Kitaoka1), Fumio Kinoshita2), Ryo Namitome3), Udai Nakamura1), Masaki Shiota3), Kenichi Goto1), Toshio Ohtsubo1), Kiyoshi Matsumura4), Yoshinao Oda2), Masatoshi Eto3) and Takanari Kitazono1) 1) Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 2) Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3) Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 4) Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Abstract. In ectopic ACTH-secreting pheochromocytoma, combined ACTH-driven hypercortisolemia and hyper‐ catecholaminemia are serious conditions, which can be fatal if not diagnosed and managed appropriately, especially when glucocorticoid-driven positive feedback is suggested with a high ACTH/cortisol ratio. A 46-year-old man presented with headache, rapid weight loss, hyperhidrosis, severe hypertension and hyperglycemia without typical Cushingoid appearance. Endocrinological examinations demonstrated elevated plasma and urine catecholamines, serum cortisol and plasma ACTH. Moreover, his ACTH/cortisol ratio and catecholamine levels were extremely high, suggesting catecholamine-dominant ACTH-secreting pheochromocytoma.
    [Show full text]
  • PROMETRIUM - Progesterone Capsule Physicians Total Care, Inc
    PROMETRIUM - progesterone capsule Physicians Total Care, Inc. ---------- Rx Only 500032 Rev Jan 2008 WARNINGS Progestins and estrogens should not be used for the prevention of cardiovascular disease. (See WARNINGS, Cardiovascular Disorders.) The Women's Health Initiative (WHI) study reported increased risks of myocardial infarction, stroke, invasive breast cancer, pulmonary emboli, and deep vein thrombosis in postmenopausal women (50 to 79 years of age) during 5 years of treatment with oral conjugated estrogens (CE 0.625 mg) combined with medroxyprogesterone acetate (MPA 2.5 mg) relative to placebo. (See CLINICAL PHARMACOLOGY, Clinical Studies.) The Women's Health Initiative Memory Study (WHIMS), a substudy of WHI, reported increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 4 years of treatment with oral conjugated estrogens plus medroxyprogesterone acetate relative to placebo. It is unknown whether this finding applies to younger postmenopausal women. (See CLINICAL PHARMACOLOGY, Clinical Studies.) Other doses of oral conjugated estrogens with medroxyprogesterone and other combinations and dosage forms of estrogens and progestins were not studied in the WHI clinical trials. In the absence of comparable data and product-specific studies, the relevance of the WHI findings to other products has not been established. Therefore, the risks should be assumed to be similar for all estrogen and progestin products. Because of these risks, estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman. DESCRIPTION PROMETRIUM® (progesterone, USP) Capsules contain micronized progesterone for oral administration. Progesterone has a molecular weight of 314.47 and a molecular formula of C21H30O2.
    [Show full text]
  • Pharmacological Management of Cushing's Disease
    Central JSM Thyroid Disorders and Management Bringing Excellence in Open Access Review Article *Corresponding author Gregory Kaltsas, Department of Pathophysiology, National University of Athens, Mikras Asias 75, 11527, Pharmacological Management Athens, Greece, Tel: 0030-210-7462513; Fax: 0030-210- 7462664; Email: Submitted: 05 December 2016 of Cushing’s Disease Accepted: 14 January 2017 Krystallenia I. Alexandraki and Gregory A. Kaltsas* Published: 15 January 2017 Department of Pathophysiology, National and Kapodistrian University of Athens, Copyright Greece © 2017 Kaltsas et al. OPEN ACCESS Abstract The role of pharmacological management of Cushing’s disease is dual, to prepare Keywords patients before any surgical intervention and to control untreated hypercortisolemia. • Cushing’s disease The latter is mainly relevant in cases of persistent disease due to surgical failure, • Pasireotide while waiting for the delayed effect of radiotherapy or as treatment in patients who • Ketoconazole are poor candidates for surgery. Drugs targeting the adrenocorticotropin-secreting • Metyrapone pituitary adenoma include the somatostatin analog pasireotide and the dopamine • Mifepristone agonist cabergoline, even though their effects are not well established as in growth • Mitotane hormone secreting adenomas or prolactinomas. Adrenal-specific therapy includes inhibitors of adrenal steroidogenesis and glucocorticoid antagonists. Metyrapone and ketoconazole help to control hypercortisolaemic states rapidly; osilodrostat and levoketoconazole have evolved as new alternatives due to their higher efficacy and less incidence of adverse effects. Mitotane may be useful in selective cases, in lower doses than those used in adrenocortical carcinoma, while etomidate is a life- saving treatment in an emergency setting. The glucocorticoid antagonist mifepristone is effective for rapid control of hypercortisolemia, but the risk of hypoadrenalism is not always acceptable.
    [Show full text]
  • Rat Prostatic Weight Regression in Reaction to Ketoconazole
    [CANCER RESEARCH 48, 6063-6068, November 1, 1988] Rat Prostatic Weight Regression in Reaction to Ketoconazole, Cyproterone Acetate, and RU 23908 as Adjuncts to a Depot Formulation of Gonadotropin-releasing Hormone Analogue Steven W. J. Lamberts,1 Piet Uitterlinden, and Frank H. de Jong Department of Medicine, Erasmus University, Rotterdam, The Netherlands ABSTRACT The effects of the s.c. administration of a depot formulation of the INTRODUCTION luteinizing hormone-releasing hormone (LHRH) analogue Zoladex were LHRH2 agonists initially stimulate pituitary gonadotropin studied in normal male rats, alone and in combination with three drugs with "antiandrogenic" action (ketoconazole, cyproterone acetate, and RU secretion resulting in an enhanced testosterone secretion, which 23908) on prostatic weight and on circulating hormone levels in order to is eventually followed by a depletion of pituitary LH stores and investigate whether these antiandrogens might prevent the LHRH-A- desensitization of LHRH receptors in the pituitary gland and of LH receptors in the gonads, and "medical" castration (1-4). induced initial increase in these parameters. These effects were compared with those caused by surgical castration. In addition the effects of the For these reasons treatment with LHRH-A results in inhibition antiandrogens on the activity of the hypothalamic-pituitary-adrenal axis of the growth of gonadal steroid-dependent tumors in humans were investigated. and animals (5-9). Several problems remain, however, with The depot LHRH analogue caused an initial increase in ventral pros regard to LHRH analogue treatment of male prostatic cancer tatic weight after 4 days but suppressed the prostatic and testicular patients: (a) the initial LHRH-induced increase in testosterone weights, the pituitary luteinizing hormone (1.11)content, and plasma LH secretion has been shown to cause a "flare-up" of the disease in and testosterone levels after 10 and 17 days.
    [Show full text]
  • Cushing's Disease
    PRIOR AUTHORI ZATI ON POLICY PO LICY: Cushing’s – Korlym® (mifepristone 300 mg tablets − Corcept) DATE REVIEWED: 05/27/2020 OVERVIEW Korlym is a cortisol receptor blocker indicated to control hyperglycemia secondary to hypercortisolism in adult patients with endogenous Cushing’s syndrome who have type 2 diabetes mellitus or glucose intolerance and have failed surgery or are not candidates for surgery.1 Korlym should not be used for the treatment of type 2 diabetes mellitus unrelated to endogenous Cushing’s syndrome. Mifepristone, the active ingredient in Korlym is also available as Mifeprex® (mifepristone 200 mg tablets) indicated for the medical termination of intrauterine pregnancy through 70 days’ pregnancy.2 Mifeprex is not included in this Prior Authorization policy. Mifepristone, the active ingredient in Korlym is a selective antagonist of the progesterone receptor (PR) at low doses and blocks the glucocorticoid type 2 receptor (GR-II) at higher doses.1 Mifepriston e h as high affinity for the GR-II receptor but little affinity for the GR-I (mineralocorticoid) receptor (MR). In addition, mifepristone appears to have little or no affinity for estrogen, muscarinic, histaminic, or monoamine receptors. Mifepristone acts at the receptor level to block the effects of cortisol, and its antagonistic actions affect the hypothalamic-pituitary-adrenal (HPA) axis in such a way as to further increase circulating cortisol levels while at the same time blocking their effects. Mifepristone and its three active metabolites have greater affinity
    [Show full text]
  • University of Birmingham Effectiveness of Metyrapone In
    University of Birmingham Effectiveness of metyrapone in treating Cushing's Syndrome Daniel, Eleni; Aylwin, Simon; Mustafa, Omar; Ball, Steve; Munir, Atif; Boelaert, Kristien; Chortis, Vasileios; Cuthbertson, Daniel J; Daousi, Christina; Rajeev, Surya P; Davis, Julian; Cheer, Kelly; Drake, William; Gunganah, Kirun; Grossman, Ashley; Gurnell, Mark; Powlson, Andrew S; Karavitaki, Niki; Huguet, Isabel; Kearney, Tara DOI: 10.1210/jc.2015-2616 License: None: All rights reserved Document Version Peer reviewed version Citation for published version (Harvard): Daniel, E, Aylwin, S, Mustafa, O, Ball, S, Munir, A, Boelaert, K, Chortis, V, Cuthbertson, DJ, Daousi, C, Rajeev, SP, Davis, J, Cheer, K, Drake, W, Gunganah, K, Grossman, A, Gurnell, M, Powlson, AS, Karavitaki, N, Huguet, I, Kearney, T, Mohit, K, Meeran, K, Hill, N, Rees, A, Lansdown, AJ, Trainer, PJ, Minder, A-EH & Newell-Price, J 2015, 'Effectiveness of metyrapone in treating Cushing's Syndrome: a retrospective multicenter study in 195 patients', The Journal of clinical endocrinology and metabolism, vol. 100, no. 11, jc20152616. https://doi.org/10.1210/jc.2015-2616 Link to publication on Research at Birmingham portal Publisher Rights Statement: Checked for eligibility: 31/03/2016 General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. •Users may freely distribute the URL that is used to identify this publication. •Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research.
    [Show full text]
  • Package Leaflet: Information for the Patient Metopirone® Capsules 250 Mg Metyrapone Read All of This Leaflet Carefully Before Y
    Package leaflet: Information for the patient Metopirone® Capsules 250 mg Metyrapone Read all of this leaflet carefully before you start taking this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet 1. What Metopirone is and what it is used for 2. What you need to know before you take Metopirone 3. How to take Metopirone 4. Possible side effects 5. How to store Metopirone 6. Contents of the pack and other information 1. What Metopirone is and what it is used for Metopirone belongs to a group of medicines called endocrine medicines. It works by decreasing the production of certain types of steroids. Metopirone is used to diagnose and treat Cushing’s syndrome (a condition when the body produces too much cortisol which is a type of steroid). It is also used to treat some types of water retention in patients suffering from certain kidney problems, cirrhosis of the liver, or heart failure. 2. What you need to know before you take Metopirone Do not take Metopirone: • if you are allergic (hypersensitive) to metyrapone or any of the ingredients of Metopirone (see Section 6) • if you are pregnant, trying to become pregnant or breast-feeding • if you suffer from an under-active adrenal gland (sometimes known as Addison’s disease).
    [Show full text]
  • 1165 Creditstone Road, Unit #1 July 1, 2010 Vaughan, Ontario L4K 4N7
    PRODUCT MONOGRAPH CYPROTERONE Cyproterone Acetate Tablets BP 50 mg Antiandrogen AA PHARMA INC. DATE OF REVISION: 1165 Creditstone Road, Unit #1 July 1, 2010 Vaughan, Ontario L4K 4N7 - 1 - PRODUCT MONOGRAPH CYPROTERONE Cyproterone Acetate Tablets BP 50 mg THERAPEUTIC CLASSIFICATION Antiandrogen ACTIONS AND CLINICAL PHARMACOLOGY Cyproterone acetate is a steroid which clinically demonstrates two distinct properties: a) Antiandrogenic: Cyproterone acetate blocks the binding of dihydrotestosterone - the active metabolite of testosterone to the specific receptors in the prostatic carcinoma cell. b) Progestogenic/antigonadotrophic: Cyproterone acetate exerts a negative feedback on the hypothalamo-pituitary axis, by inhibiting the secretion of LH leading to diminished production of testicular testosterone. The absorption of cyproterone acetate following oral administration is complete. Peak plasma levels are reached 3 - 4 hours after administration. Plasma levels fall rapidly during the first 24 hours as a result of tissue distribution and excretion, and plasma half-life was 38 ± 5 hours. Most of the cyproterone acetate is excreted unchanged in the feces (60%) or urine (33%) within 72 hours. Cyproterone acetate is eliminated with the urine mainly in the form of unconjugated metabolites and with the bile (feces) in the form of glucuronidized metabolites. The principal metabolite identified was 15β-hydroxy-cyproterone acetate. - 2 - Comparative Bioavailability A standard, randomized, two-way crossover study was conducted in 18 healthy, adult, male
    [Show full text]