Análise do tratamento com dose única do análogo do GnRH (acetato de gosserrelina - 10,8 mg) em pacientes com leiomiomatose uterina atendidas no Ambulatório de Ginecologia Endócrina de um Hospital Terciário de Curitiba / Analysis of single dose GnRH analog (goserelin acetate – 10.8 mg) treatment in patients with uterin leiomyomatosis treated at the Outpatient Clinic of Endocrine Gynecology of a Tertiary Hospital in Curitiba

Autor: Anna Paula Bueno Haurani, Sheldon Rodrigo Botogoski, Patricia Arenas Rocha, Ariadne Decarli, Mila Schettini de Andrade, Flávia Centenaro de Oliveira
Rok vydání: 2021
Předmět:
Zdroj: Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo; v. 66 (2021): Jan/Dez; 1-8
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo
Faculdade de Ciências Médicas da Santa Casa de São Paulo
instacron:FCMSCSP
ISSN: 1809-3019
0101-6067
DOI: 10.26432/1809-3019.2021.66.031
Popis: Introdução: Leiomiomas são tumores benignos que surgem no miométrio e são comuns em mulheres em idade fértil. Eles podem ser assintomáticos ou podem estar associados a sintomas pélvicos, como sangramento e dor. Objetivo: Neste presente estudo, foram analisadas situações clínicas de 64 mulheres portadoras de leiomiomatose uterina sintomática que foram submetidas ao tratamento com a injeção de análogo de GnRH (agonista do hormônio liberador de gonadotrofina), sendo acompanhadas no período de 2009- 2019. Material e Método: Os dados foram coletados de prontuários do ambulatório de Ginecologia do Hospital Santa Casa de Curitiba. Trata-se de um método observacional,retrospectivo com variáveis quantitativas e qualitativas. Os critérios de inclusão foram mulheres portadoras de leiomiomatose uterina comprovada por ultrassonografia e quese submeteram ao tratamento com o análogo de GnRH. A quantificação da redução do volume uterino após aplicação do GnRH; avaliação na melhora dos níveis hematimétricos;mensuração e discriminação de quantas pacientes foram submetidas a cirurgia e correlação com a história clínica; a aferição de qual cirurgia foi mais realizada e a identificação das queixas pré e pós aplicação da injeção correspondem aos objetivos encontrados no atual estudo. Resultados: O uso com análogo de GnRH pré-operatório contribuiu para melhora dos índices hematimétricos onde se foi observado um aumento médio de 20,1% de hemoglobina. Além disso, a pré-aplicação colaborou com uma redução de volumeuterino em 90,6% das pacientes. Mediante isso, obteve-se um cenário cirúrgico mais seguro para as 23 pacientes que necessitaram de cirurgia, seja via histerectomia abdominal, vaginal ou mesmo miomectomia. Concordante com o arsenal literário, neste estudo observou-se que as queixas principais pré aplicação do análogo foram sangramento uterino anormal e dismenorreia; assim como a queixa pós injeção foi principalmente o fogacho, que ocorre devido ao estado de hipoestrogenismo o qual o GnRH ocasiona. Conclusão: À luz dessas evidências, o análogo de GnRH traz inúmeros benefícios, como tratamento terapêutico e pré-operatório da leiomiomatose uterina, porém seus efeitos adversos e seu alto custo contribuem para a menor acessibilidade às pacientes. Palavras-chave: Leiomiomatose, Gosserrelina, Sangramento uterino, Infertilidade, Dor pélvica, Dismenorreia ABSTRACT Introduction: Leiomyomas are benign tumors that appear in the myometrium and are common in women of childbearing age. They may be asymptomatic or may be associatedwith pelvic symptoms, such as bleeding and pain. Objective: In the present study, we analyzed clinical situations of 64 women with symptomatic uterine leiomyomatosis whounderwent treatment with GnRH analogue (gonadotropin releasing hormone agonist) injection, these patients were followed up in 2009-2019. Data were collected from medicalrecords of the Gynecology outpatient clinic of the Santa Casa Hospital in Curitiba. Material and Method: It is an observational, retrospective study, with quantitative andqualitative variables. Inclusion criteria were women with ultrasound-proven uterine leiomyomatosis who underwent GnRH analogue treatment. Quantification of uterinevolume reduction after GnRH application; assessment of improvement in hematimetric levels; measurement and discrimination of how many patients underwent surgeryand correlation with clinical history; the assessment of which surgery was mostly performed and the identification of complaints before and after injection correspond to theobjectives found in the current study. Results: The use of preoperative GnRH analogue contributed to the improvement of hematimetric indices, in which an average increaseof hemoglobin of 20.1% was observed, and pre-application contributed to a reduction of uterine volume by 90.6% of the patients. Thus, a safer surgical scenario was obtainedfor the 23 patients who required surgery, whether abdominal or vaginal hysterectomy, or even myomectomy. In accordance with the literary arsenal, this study noted thatthe main complaints – pre-application of the analogue – were abnormal uterine bleeding and dysmenorrhea; just as the complaint after injection was mainly of hot flashes, that occurs due to the state of hypoestrogenism, caused by the GnRH. Conclusion: Considering this evidence, the GnRH analogue has numerous benefits as a therapeutic and preoperative treatment for uterine leiomyomatosis; its adverse effects and high cost, however, contribute to loweraccessibility to patients. Keywords: Leiomyomatosis, Goserelin, Uterine bleeding, Infertility, Pelvic pain, Dysmenorrhea Introduction: Leiomyomas are benign tumors that appear in the myometrium and are common in women of childbearing age. They may be asymptomatic or may be associated with pelvic symptoms, such as bleeding and pain. Objectives: In the present study, we analyzed clinical situations of 64 women with symptomatic uterine leiomyomatosis who underwent treatment with GnRH analogue (gonadotropin releasing hormone agonist) injection, these patients were followed up in 2009-2019. Data were collected from medical records of the Gynecology outpatient clinic of the Santa Casa Hospital in Curitiba. Method: It is an observational, retrospective study, with quantitative and qualitative variables. Inclusion criterias were women with ultrasound-proven uterine leiomyomatosis who underwent GnRH analogue treatment. Quantification of uterine volume reduction after GnRH application; assessment of improvement in hematimetric levels after analogue application; measurement and discrimination of how many patients underwent surgery and correlation with clinical history; the assessment of which surgery was most performed and the identification of complaints before and after injection correspond to the objectives found in the current study. Results: In fact, the use of preoperative GnRH analogue contributed to the improvement of hematimetric indices, in which an average increase of hemoglobin of 20.1% was observed, and pre-application contributed to a reduction of uterine volume by 90.6% of the patients. Thus, a safer surgical scenario was obtained for the 23 patients who required surgery, whether via abdominal, vaginal hysterectomy or even myomectomy. In line with the literary arsenal, this study noted that the main complaints – pre-application of the analogue – were abnormal uterine bleeding and dysmenorrhea; just as the complaint after injection was mainly the hot flush, that occurs due to the state of hypoestrogenism, caused by the GnRH. Conclusion: In light of this evidence, the GnRH analogue has numerous benefits as a therapeutic and preoperative treatment for uterine leiomyomatosis; its adverse effects and high cost, however, contribute to lower accessibility to patients.
Databáze: OpenAIRE
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