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Over the past decade, the occurrence and removal of emerging contaminants in the environment has received much attention. Both natural and synthetic progestogens, which are hormones, and also benzotriazoles are two examples of such emerging contaminants. Sewage treatment works are recognised as one of the main routes of these compounds to the environment. Low concentrations (nanograms per litre) of biologically active chemicals may exhibit an impact on aquatic organisms and human health. This study was undertaken to determine the occurrence and removal of these two classes of chemicals at sewage treatment works, along with an evaluation of the performance of advanced treatment and also to investigate their fate in the aquatic environment. Therefore, field-based sampling campaigns were undertaken at a sewage treatment works, rivers and potable water to achieve these aims. Solid phase extraction and LC/MS/MS were used in order to analyse the samples from these different locations, along with catchment modelling and assessment of how the use of benzotriazoles may contribute to their presence in the environment. The results have demonstrated that progestogens and benzotriazoles are in the sewage system; the natural hormone (progesterone) was the most predominant compound entering the sewage treatment work (46.9 ng/l) among the progestogens while concentrations of the benzotriazoles were two orders of magnitude higher than the progestogens. The conventional sewage treatment works were, to some extent, able to remove these compounds from wastewaters. However, this may not be adequate to afford protection to the environment. The investigation of advanced treatments, ozone, granular activated carbon and chlorine dioxide, indicated no further significant removal of progestogens, probably as a result of concentrations being close to method detection limits. However, there were indications that benzotriazoles were removed. A degradation study demonstrated that the natural hormone (progesterone) was degraded rapidly while benzotriazoles were not degraded. Catchment modelling indicated that high (up to 2,000 ng/l) concentrations of benzotriazoles would be present in surface waters used for potable supply, and consequently benzotriazoles were found in the tap water with mean concentrations of 30.9 ng/l (benzotriazole) and 15.1 ng/l for tolyltriazole. It is therefore apparent that although conventional treatment may be seen as effective, achieving over 90% removal, this may not be good enough. However, before investing in tertiary treatment, a number of factors, such as the effectiveness at different sites, the presence of degradation products and costs, both financial and in relation to energy use, need to be considered.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniversitet, 2005. / Härtill 4 uppsatser.

abstract: Progestogens, such as progesterone (P4), medroxyprogesterone acetate (MPA), and micronized progesterone (mP4), are given to ovary-intact women during the transition to menopause to attenuate heavy uterine bleeding and other symptoms. Both progesterone and MPA administration have been shown to impair cognition in ovariectomized (Ovx) rats compared to vehicle-treated controls. mP4, however, has yet to be investigated for cognitive effects in a preclinical setting. Further, progestogens affect the GABA (-aminobutyric acid) ergic system, specifically glutamic acid decarboxylase (GAD) the rate limiting enzyme necessary for synthesizing GABA. The goal of this experiment was to investigate the cognitive impact of P4, MPA, and mP4, in an ovary-intact transitional menopause model using 4-vinylcyclohexene diepoxide (VCD) and assess whether these potential changes were related to the GABAergic system. One group of rats received vehicle injections, and the remainder of the groups received VCD to induce follicular depletion, modeling transitional menopause in women. Vehicle or hormone administration began during perimenopause to model the time period when women often take progestogens alone. Rats then underwent testing to assess spatial working and reference memory in the water radial-arm maze (WRAM) and spatial reference memory in the Morris water maze (MWM). Results indicate that P4 and MPA improved learning for working memory measure, but only MPA impaired memory retention in the WRAM. For the WRAM reference memory measure, VCD only treated rats showed impaired learning and memory retention compared to vehicle controls; progestogens did not impact this impairment. Although GAD expression did not differ between treatment groups, in general, there was a relationship between GAD expression and WRAM performance such that rats that tended to have higher GAD levels also tended to make more WRAM working memory errors. Thus, while P4 and MPA have been previously shown to impair cognition in an Ovx model, giving these hormones early in an ovary-intact perimenopause model elicits divergent effects, such that these progestogens can improve cognition. Additionally, these findings suggest that the cognitive changes seen herein are related to the interaction between progestogens and the GABAergic system. Further investigation into progestogens is warranted to fully understand their impact on cognition given the importance of utilizing progestogens in the clinic. / Dissertation/Thesis / Masters Thesis Psychology 2019

Made available in DSpace on 2014-07-29T15:25:18Z (GMT). No. of bitstreams: 1 Tese Marta Finotti.pdf: 3895789 bytes, checksum: 34013da0160fa8b597d77b68baeab9c9 (MD5) Previous issue date: 2011-05-30 / INTRODUCTION: The dissolution profile of a drug is an important tool for evaluating its biopharmaceutical quality. The pharmaceutical form must be guaranteed to release the appropriate quantity of the drug at the appropriate rate to assure that the therapeutic objective of the product, which is directly related to its bioavailability, will be achieved. In order to permit interchangeability between medications, quality, safety and efficacy must first be guaranteed. Failure to comply with these conditions may result in therapeutic failure. OBJECTIVES: To evaluate the dissolution profile of the principal pharmaceutical forms of progestogens available on the market in Brazil for luteal phase support in infertility treatment. METHODS: A laboratory study was developed and conducted in the Pharmaceutical Technology Laboratory of the School of Pharmacy, Federal University of Goiás (UFG). The following formulations were evaluated: coated tablets of dydrogesterone, micronized progesterone in the form of soft gelatin capsules produced by two different pharmaceutical companies (product A and product B) and a gel form. The study also included suppositories and ovules from three compounding pharmacies. Evaluation was made using physical and physicochemical tests and in vitro release assays. In the case of the pharmaceutical preparations in the form of soft gelatin capsules, dissolution kinetics and dissolution efficacy were also determined in addition to the profile of the preparation. The products with the same pharmaceutical form were compared. Different equipment, a dissolution apparatus equipped with an Enhancer Cell assembly and Franz diffusion cells, were tested and also compared in an attempt to determine the best method of evaluating semisolid forms. Statistical analysis was performed using the SPSS statistical software program for Windows, version 16.0. ANOVA, the Tukey test and Student s t-test were used in the comparative analysis. RESULTS: Evaluation of dydrogesterone in the pharmaceutical form of coated tablets showed the product to be in accordance with pharmacopeial specifications. The tablets were approved in the first stage of the dissolution assay, drug dissolution being above 85% at 60 minutes for all the units tested. With respect to the dissolution profile of the three batches of the micronized progesterone products evaluated (products A and B), in the form of soft gelatin capsules from different pharmaceutical companies, drug dissolution within 4 hours was 80%, i.e. all the products met the established dissolution specifications. The dissolution profiles and first-order kinetics of products A and B, which consisted of micronized progesterone in the form of soft gelatin capsules, were similar. The dissolution apparatus equipped with an Enhancer Cell assembly was found to constitute the best means of characterizing the rate and extent of release of the drug in gel form from its matrix. The in vitro release assay for micronized progesterone in the form of soft gelatin capsules conducted in the dissolution apparatus confirmed the prolonged release mechanism of the drug, which lasted for up to 72 hours. None of the ovules or suppositories from any of the compounding pharmacies evaluated met the criteria established by the regulatory agencies and official compendia with respect to the quality requirements for drugs. The dissolution profile differed between batches and between the different pharmacies investigated. Mean maximum concentrations of micronized progesterone failed to exceed 80% of the dose stated on the label. Statistically significant differences were found between batches originating from the same pharmacy and between the different pharmacies investigated. CONCLUSIONS: It was impossible to establish the interchangeability of the reference products with the compounded products tested. Further bioavailability studies and randomized clinical trials should be conducted to test the different products with the best performance in the dissolution studies conducted. / INTRODUÇÃO - O perfil de dissolução do fármaco representa uma importante ferramenta para avaliar a qualidade biofarmacêutica do medicamento. É necessário que se garanta que a forma farmacêutica libere o fármaco na quantidade e na velocidade adequadas ao objetivo terapêutico do produto, o que está diretamente relacionado à sua biodisponibilidade. Para que possa haver intercambialidade entre medicamentos, é necessário que, primeiro, esteja garantida a qualidade, segurança e eficácia. A inobservância de tal preceito pode ser responsável pela falência terapêutica. OBJETIVOS: Avaliar o perfil de dissolução das principais formas farmacêuticas de progestagênios disponíveis no mercado brasileiro para suporte de fase lútea no tratamento de infertilidade. MÉTODOS: Foi realizado estudo laboratorial, desenvolvido no Laboratório de Tecnologia Farmacêutica da Faculdade de Farmácia da Universidade Federal de Goiás (UFG). Foram avaliados comprimidos revestidos de didrogesterona, progesterona micronizada veiculada em cápsulas de gelatina mole, provenientes de dois laboratórios diferentes, produto A e produto B, bem como a forma veiculada em gel. O estudo abrangeu também supositórios e óvulos provenientes de três farmácias magistrais. A avaliação foi realizada por meio de testes físicos, físico-químicos e ensaios de liberação in vitro. Para as formas farmacêuticas em cápsulas de gelatina mole, foi determinado, além do perfil, a cinética e a eficiência de dissolução. Os produtos com a mesma forma farmacêutica foram comparados. Equipamentos diferentes, o Dissolutor com acessório Enhancer Cells e Células de Difusão tipo Franz, foram testados e também comparados na tentativa de se determinar o melhor método de avaliação para as formas semissólidas. A análise estatística foi realizada no programa SPSS, versão 16.0 for Windows. Os testes aplicados foram Anova, Tukey e t de Student. RESULTADOS: A avaliação da didrogesterona, sob a forma de comprimidos revestidos, demonstrou que o produto se apresenta de acordo com as especificações farmacopeicas. Os comprimidos foram aprovados em primeiro estágio no ensaio de dissolução, pois todas as unidades apresentaram mais de 85% do fármaco dissolvido ao final de 60 minutos. O perfil de dissolução dos três lotes dos produtos avaliados (A e B) de progesterona micronizada sob a forma de cápsulas de gelatina mole, provenientes de diferentes laboratórios farmacêuticos, demonstrou que houve dissolução de 80% do fármaco até a quarta hora de estudo, ou seja, todos estavam dentro das especificações definidas no método de dissolução. . Os produtos A e B de progesterona micronizada sob a forma de cápsulas de gelatina mole, apresentaram perfis de dissolução semelhantes e cinética de primeira ordem. O equipamento Dissolutor com acessório Enhancer Cells se mostrou mais adequado para caracterizar a velocidade e extensão de liberação do fármaco veiculado em gel, a partir da matriz. O ensaio de liberação in vitro da progesterona micronizada, veiculada em gel, no Dissolutor, comprovou o mecanismo de liberação prolongada do fármaco, que se manteve por um período de 72 horas. Os óvulos e supositórios das farmácias magistrais não atenderam os critérios estabelecidos pelas agências reguladoras e compêndios oficiais quanto aos requisitos de qualidade para medicamentos. O perfil de dissolução mostrou-se diferente entre os lotes analisados e entre as farmácias avaliadas. A média das concentrações máximas de progesterona micronizada não ultrapassou 80% da dose declarada no rótulo. Houve diferenças estatisticamente significativas com relação à média das concentrações de progesterona entre lotes da mesma farmácia e entre as farmácias pesquisadas. CONCLUSÕES: Não é possível estabelecer intercambialidade dos produtos referência com os produtos manipulados testados. É necessário que se dê continuidade por meio de estudos de biodisponibilidade e ensaios clínicos randomizados, testando os diferentes produtos, dentre os que mostraram melhor desempenho nos estudos de dissolução realizados.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2016-02-01T10:31:20Z No. of bitstreams: 2 Tese - Rafael Alves da Costa Ferro - 2015.pdf: 1256523 bytes, checksum: ec4d2c65cb4bd6adabfc7a88a25cdf99 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-02-01T11:21:54Z (GMT) No. of bitstreams: 2 Tese - Rafael Alves da Costa Ferro - 2015.pdf: 1256523 bytes, checksum: ec4d2c65cb4bd6adabfc7a88a25cdf99 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2016-02-01T11:21:54Z (GMT). No. of bitstreams: 2 Tese - Rafael Alves da Costa Ferro - 2015.pdf: 1256523 bytes, checksum: ec4d2c65cb4bd6adabfc7a88a25cdf99 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-12-08 / A large number of heifers and cows are used in Brazil for the production of meat, mainly due to the disposal of these animals on farms at the time of the herd replacement. The aim of this study was to evaluate the influence of a synthetic-progesterone ear implant in weight, meat quality, physiological responses, and behavior of Nellore heifers raised in an intensive system. Twenty-eight Nellore heifers with an average initial weight of 240.89 kg were used in the experiment. All animals received the same feeding management, in an intensive raising system, with mineral salt and water available ad libitum. Heifers were distributed in a randomized complete design with two treatments (with and without a progesterone ear implant) and seven replicates, in 14 stalls. The parameters relative to carcass and meat quantitative and qualitative characteristics, represented by carcass weight and carcass dressing, conformation, marbling, color, meat texture, carcass measurements, longissimus dorsi area, and fat thickness were not affected by the progesterone hormone, provided by the ear implant. In the evaluation of the feeding, rumination, rest, sleeping, social, and body-care behaviors, no significant differences were observed. For the abnormal behavior, however, in which sodomy predominated, a significant difference was observed between the groups with and without the implant (p<0,05), whose frequencies were 1.3 and 2.3, respectively. For the physiological indicators rectal temperature, surface temperature, and respiratory frequency, only the frequency showed a significant difference between the treatments, with mean values of 35 and 32 movements per minute, respectively, for the heifers with and without the implant. Based on the responses obtained in this experiment, the progesterone ear implant does not influence the performance, meat quality, physiological responses, or the normal behavior of animals. / Um grande número de novilhas e vacas são utilizadas no Brasil para a produção de carne, principalmente em decorrência do descarte desses animais nas propriedades rurais, no momento da substituição do rebanho. Objetivou-se avaliar a influência do implante auricular de progesterona sintética, no peso, qualidade de carne, respostas fisiológicas e comportamento de novilhas Nelore criados em sistema intensivo. Foram utilizadas 28 novilhas Nelore com peso inicial médio de 240,89 kg. Todos os animais receberam o mesmo manejo alimentar, em sistema intensivo de criação, com sal mineral e água ad libitum. Foram distribuídas em delineamento inteiramente casualizado, com dois tratamentos (com e sem implante auricular de progesterona) e sete repetições, em 14 baias. Os parâmetros referentes às características quantitativas e qualitativas da carcaça e da carne, representados pelo peso e rendimento da carcaça, conformação, marmoreio, coloração, textura da carne, medidas métricas da carcaça, área do músculo Longissimus dorsi e espessura de gordura subcutânea, não foram afetados pelo hormônio progesterona, disponibilizado por meio do implante auricular. Na avaliação dos comportamentos de alimentação, ruminação, descanso e sono, social e cuidados corporais, não foram observados diferenças significativas. Já para o comportamento anormal, com maior predominância de sodomia, houve diferença significativa (p<0,05) para os grupos com e sem implante, com frequências de 1,3 e 2,3, respectivamente. Para os indicadores fisiológicos, temperatura retal, temperatura de superfície e frequência respiratória, apenas a frequência apresentou diferença significativa entre os tratamentos, com valores médios de 35 e 32 movimentos por minuto, respectivamente, para novilhas com e sem implante. Considerando as respostas obtidas com o experimento, o implante auricular de progesterona não influencia o desempenho, a qualidade da carne, as respostas fisiológicas e o comportamento normal dos animais.

L’hypothèse de l’hormono-dépendance du mélanome cutané est en débat dans la littérature depuis de nombreuses années. Dans ce contexte, il est essentiel de mieux connaître l’influence potentielle de la prise de traitements hormonaux sur le risque de ce cancer.L’objectif de ce projet de thèse était d’étudier l’influence de la prise de traitements hormonaux (contraceptifs oraux, traitements de l’infertilité, progestatifs pris seuls avant la ménopause et traitements hormonaux de la ménopause) sur le risque de mélanome cutané chez les femmes.Le projet a été conduit principalement à partir de la cohorte prospective E3N (Étude épidémiologique auprès de femmes de l’Éducation nationale) portant sur environ100 000 femmes âgées de 40 à 65 ans à l’inclusion en 1990. L’étude E3N inclut des données détaillées sur le profil pigmentaire, l’exposition solaire et la prise de traitements hormonaux des participantes, ainsi que sur la survenue éventuelle de mélanome cutané, dont les cas ont été confirmés par histologie (761 cas confirmés entre 1990 et 2011). Des données complémentaires sur l’exposition solaire, disponibles pour une fraction de la cohorte E3N, ont également été utilisées. Ces données détaillées sont issues de l’enquête cas-témoin nichée E3N-SunExp menée en 2008. Les analyses ont ensuite été étendues au consortium de cohortes européennes prospectives EPIC (European Prospective Investigation into Cancer and Nutrition), sur près de 334 500 femmes parmi lesquelles 1 734 cas de mélanomes incidents ont été diagnostiqués.Les résultats mettent en évidence des associations modestes entre la prise de traitements hormonaux et le risque de mélanome et ne soutiennent pas l’hypothèse de l’hormono-dépendance de ce cancer. Cependant, ils suggèrent un comportement d’exposition intentionnelle aux UV chez leurs utilisatrices, ce qui ouvre une nouvelle perspective pour les recherches futures dans ce domaine. / The hypothesis of a hormonal dependence of cutaneous melanoma has been debated in the literature over past decades. Within this context, it is critical to increase our knowledge on the influence of exogenous hormone use on the risk of this cancer.The aim of this project was to explore the influence of hormonal treatments (oral contraceptives, fertility drugs, premenopausal use of progestogens, and menopause hormone therapy) on the risk of cutaneous melanoma in women.The project was mainly based on the large E3N (Étude épidémiologique auprès de femmes de l’Éducation Nationale) prospective cohort, which included about 100,000 women aged 40-65 years at inclusion in 1990. The cohort collected data on pigmentary phenotype, sun exposure, hormonal treatment use, and medical data including cutaneous melanomas, which were ascertained through pathology reports (761 incident cases between 1990 and 2011). Additional information on sun exposure, available for a portion of the E3N cohort, was used. These detailed data were collected as part of the E3N-SunExp case-control study launched in 2008.Analyses were extended to the EPIC consortium (European Prospective Investigation into Cancer and Nutrition), which includes about 334 500 women and 1,734 incident melanoma cases.The results arising from this project show modest associations between exogenous hormone use and melanoma risk and suggest no strong direct influence of hormones on melanoma development. However, results suggest intentional UV exposure behaviors in exogenous hormone users, which opens new perspectives for future investigations in this field.

At present, the issue of occurrence of female sex hormones, estrogens and progestogens, in aquatic ecosystems is often discussed by experts and the general public. These substances of steroid structure can be difficult to remove completely by conventional wastewater and drinking water treatment technologies. In given context advanced oxidation processes based on in situ generation of highly reactive hydroxyl radicals can be a suitable technique. This thesis deals with the study of kinetics and degradation products of photocatalytic decomposition of seven female sex hormones (estrone, -estradiol, estriol, ethinylestradiol, diethylstilbestrol, progesterone and norethindrone). Experiments were conducted in a laboratory glass reactor, which was equipped with an energy efficient UV-A LED light source (365 nm emission wavelength) and an immobilised photocatalyst in a form of TiO2 five-layer film deposited on glass. Model samples of water with the initial hormone concentration of 1 mg·L-1 were used and the degradation process was monitored by an HPLC-MS method. In the given system all compounds of interest except estriol had very significant tendency to be adsorb. In the case of estriol the formal rate constant of photocatalytic decomposition was determined based on the Langmuir-Hinshelwood model for two different initial concentrations, 0.5527 hour-1 (1 mg·L-1) and 0.1929 hour-1 (5 mg·L-1), and by comparison of these values it was found that the higher degraded compound concentration, the slower decomposition (fivefold increase of the initial concentration resulted in the constant decrease to almost one-third). Moreover nine degradation products of estriol photocatalytic decomposition were recorded and their structure was designed based on mass spectra. In the second thematic part of the thesis attention was paid to development of a SPE-HPLC-MS method for simultaneous determination of female sex hormones in water ecosystems, with emphasis on an extraction part optimization. The final samples treatment process included besides extraction with Supel™ Select HLB 200 mg SPE cartridges also mechanical impurities removal, hormones extraction from solids trapped on filtration material, sample acidification and extract purification with Supelclean™ ENVI-Florisil® cartridges. Optimised method was used for determination of female sex hormones in two Brno rivers, Svitava and Svratka. In the most cases the concentration was below the detection or quantification limit.

O tratamento do hipogonadismo hipogonadotrófico na mulher adulta com hipopituitarismo inclui diversas alternativas terapêuticas de estrógenos e progestágenos, sendo a via oral a de menor custo e a de maior comodidade à paciente. A rota estrogênica oral, entretanto, exerce marcada influência sobre o eixo hormônio de crescimento/fator de crescimento insulinasímile número 1 (GH/IGF-1) nessas mulheres. O tratamento com estrógenos orais, concomitante ao uso de GH em pacientes com hipopituitarismo, antagoniza as ações biológicas do GH e agrava as anormalidades de composição corporal e o metabolismo em geral. Presume-se que o estrógeno oral iniba a secreção/produção de IGF-1 através de um efeito de primeira passagem hepática, causando um aumento da secreção de GH através de inibição do feedback negativo de IGF-1 em mulheres normais. Isso é demonstrado clinicamente por redução da massa magra, aumento da massa gorda, perfil lipídico aterogênico e prejuízo do bem-estar psicológico. Alguns estudos apontam que os progestágenos com ação androgênica revertem o efeito de diminuição dos níveis séricos de IGF-1 induzida pelos estrógenos orais. Progestágenos neutros não apresentam esse efeito, porém, quanto maior a potência androgênica, maior será a reversão do efeito de diminuição de IGF-1. Na presente revisão da literatura, serão abordados os aspectos clínicos da reposição com estrógenos e progestágenos nas mulheres com hipopituitarismo, suas interações nas outras deficiências hormonais, bem como o impacto do uso de estrógenos sobre as ações metabólicas do GH. / Treatment of hypogonadotropic hypogonadism in adult woman with hypopituitarism can include a wide range of estrogen and progestogen treatment alternatives, and oral administration is the route of least cost and greatest patient comfort. The oral estrogen route has a major impact on the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. Oral estrogen therapy, when given concurrently with GH to patients with hypopituitarism, antagonizes the biological effects of GH treatment and aggravates the abnormalities of body composition and the metabolism in general. It is presumed that oral estrogen suppresses the secretion/production of IGF-1 by a hepatic first-pass mechanism, resulting in increased GH secretion by means of suppressing the IGF-I negative feedback that is present in healthy women. This is manifest clinically in reduced lean body mass, increased fat mass, an atherogenic lipid profile and damage to psychological well-being. Some studies have indicated that progestogens with androgenic actions reverse the effect of reduced serum IGF-1 levels that is induced by the oral estrogens. Neutral progestogens do not exert this effect, however the stronger the androgenic potential, the more the effect of reduced IGF-1 will be reversed. This bibliographical review will deal with the clinical aspects of estrogen and progestogen replacement in women with hypopituitarism, their interactions with other hormone deficiencies and the impact of estrogen treatment on the metabolic actions of GH.

O tratamento do hipogonadismo hipogonadotrófico na mulher adulta com hipopituitarismo inclui diversas alternativas terapêuticas de estrógenos e progestágenos, sendo a via oral a de menor custo e a de maior comodidade à paciente. A rota estrogênica oral, entretanto, exerce marcada influência sobre o eixo hormônio de crescimento/fator de crescimento insulinasímile número 1 (GH/IGF-1) nessas mulheres. O tratamento com estrógenos orais, concomitante ao uso de GH em pacientes com hipopituitarismo, antagoniza as ações biológicas do GH e agrava as anormalidades de composição corporal e o metabolismo em geral. Presume-se que o estrógeno oral iniba a secreção/produção de IGF-1 através de um efeito de primeira passagem hepática, causando um aumento da secreção de GH através de inibição do feedback negativo de IGF-1 em mulheres normais. Isso é demonstrado clinicamente por redução da massa magra, aumento da massa gorda, perfil lipídico aterogênico e prejuízo do bem-estar psicológico. Alguns estudos apontam que os progestágenos com ação androgênica revertem o efeito de diminuição dos níveis séricos de IGF-1 induzida pelos estrógenos orais. Progestágenos neutros não apresentam esse efeito, porém, quanto maior a potência androgênica, maior será a reversão do efeito de diminuição de IGF-1. Na presente revisão da literatura, serão abordados os aspectos clínicos da reposição com estrógenos e progestágenos nas mulheres com hipopituitarismo, suas interações nas outras deficiências hormonais, bem como o impacto do uso de estrógenos sobre as ações metabólicas do GH. / Treatment of hypogonadotropic hypogonadism in adult woman with hypopituitarism can include a wide range of estrogen and progestogen treatment alternatives, and oral administration is the route of least cost and greatest patient comfort. The oral estrogen route has a major impact on the growth hormone-insulin-like growth factor I (GH-IGF-I) axis. Oral estrogen therapy, when given concurrently with GH to patients with hypopituitarism, antagonizes the biological effects of GH treatment and aggravates the abnormalities of body composition and the metabolism in general. It is presumed that oral estrogen suppresses the secretion/production of IGF-1 by a hepatic first-pass mechanism, resulting in increased GH secretion by means of suppressing the IGF-I negative feedback that is present in healthy women. This is manifest clinically in reduced lean body mass, increased fat mass, an atherogenic lipid profile and damage to psychological well-being. Some studies have indicated that progestogens with androgenic actions reverse the effect of reduced serum IGF-1 levels that is induced by the oral estrogens. Neutral progestogens do not exert this effect, however the stronger the androgenic potential, the more the effect of reduced IGF-1 will be reversed. This bibliographical review will deal with the clinical aspects of estrogen and progestogen replacement in women with hypopituitarism, their interactions with other hormone deficiencies and the impact of estrogen treatment on the metabolic actions of GH.