Endocrine: Gonadotrophins

Question 1

Danazol is a gonadotrophin-affecting drug licensed for what? (3)

Answer 1

1. Endometriosis
2. Relief of severe pain and tenderness in benign fibrocystic breast disease
3. Hereditary angioedema

Question 2

Cetrorelix and ganirelix are gonadotrophin-affecting drugs. What class of drug are they?

Answer 2

Cetrorelix and ganirelix are luteinising hormone releasing hormone antagonists: they inhibit the release of gonadotrophins such as luteinising hormone and follicle stimulating hormone.

They are used in the treatment of infertility by assisted reproductive techniques.

Question 3

Cetrorelix and ganirelix are luteinising hormone releasing hormone antagonists, which inhibit the release of gonadotrophins. What are the gonadotrophins?

Answer 3

Luteinising hormone and follicle stimulating hormone.

Cetrorelix and ganirelix are used in the treatment of infertility by assisted reproductive techniques.

Question 4

Which of the following is NOT a use of gonadorelin analogues?

Treatment of endometriosis
Precocious puberty
Infertility 
Male hypersexuality with severe sexual deviation
Following intra-uterine surgery
Breast Cancer
Prostate Cancer

Answer 4

Use of leuprorelin acetate and triptorelin for 3 to 4 months BEFORE surgery reduces the uterine volume, fibroid size and associated bleeding.

For women undergoing hysterectomy or myomectomy, a vaginal procedure is made more feasible following use of a gonadorelin analogue.

Currently it is not recommended to use gonadorelin analogues post surgery:

https://www.researchgate.net/publication/11672485_Post-Operative_GnRH_Analogue_Treatment_After_Conservative_Surgery_for_Symptomatic_Endometriosis_Stage_III-IV_A_Randomized_Controlled_Trial

Question 5

What are the options for breast pain (which has not responded to reduction in dietary fat; withdrawal of an oral contraceptive or of hormone replacement therapy)? (2)

Answer 5

Danazol is licensed for the relief of severe pain and tenderness in benign fibrocystic breast disease which is unresponsive to other treatment.

Tamoxifen may be a useful adjunct in the treatment of mastalgia - especially when symptoms can definitely be related to cyclic oestrogen production; it may be given on the days of the cycle when symptoms are predicted.