Deteriorated arterial supply to the lower limb during oral oestrogen therapy of patients with prostatic carcinoma.
Patients with prostatic carcinoma were randomised to treatment with surgical castration (n = 47) or oral oestrogen therapy (n = 53). The oestrogen-treated patients received oral ethinyl oestradiol daily, 1 mg for the first 2 weeks followed by 150 micrograms. In addition, oestrogen was given intramuscularly as polyoestradiol phosphate monthly 160 mg for 3 months, continued by 80 mg. Before and 1 year after therapy systolic arm and toe blood pressures were measured. Eleven percent of the patients in the oestrogen group had a pathological pressure difference between the arm and toe before treatment versus 34% in the orchidectomy group. Despite the greater proportion of subclinical atherosclerotic disease in the legs of the patients in the orchidectomy group, the patients in the oestrogen group only had signs and symptoms of a deterioration of the arterial system. Thus, in the oestrogen group the arm-toe blood pressure difference increased from 20 +/- 3 to 32 +/- 4 mm Hg (p < 0.001) and the proportion of pathological toe pressures increased from 11 to 29% (p = 0.0014). Two of the patients in this group had to be referred for reconstructive surgery due to severe intermittent claudication. In addition, 5 more patients in this group suffered arterial ischemic events in the coronary and cerebral vasculatures. In contrast, there were no clinical ischemic events in the orchidectomy group and no change in the blood pressure difference between the arm and toe 1 year after orchidectomy. In conclusion, oral oestrogen therapy, in contrast to orchidectomy, induces a deterioration of the arterial supply to the lower limbs during the 1st year of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Henriksson
P
P
Department of Medicine, Södertälje Hospital, Sweden.
Linde
B
B
D000284:Administration, Oral; D000368:Aged; D000704:Analysis of Variance; D001132:Arm / Q000098:blood supply / Q000503:physiopathology; D001158:Arteries; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology; D004958:Estradiol / Q000031:analogs & derivatives / Q000627:therapeutic use; D045166:Estradiol Congeners / Q000627:therapeutic use; D004997:Ethinyl Estradiol / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology; D007866:Leg / Q000098:blood supply* / Q000503:physiopathology; D008297:Male; D009919:Orchiectomy; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D012307:Risk Factors; D014034:Toes / Q000098:blood supply / Q000503:physiopathology; D016896:Treatment Outcome
D045166:Estradiol Congeners; D004997:Ethinyl Estradiol; D004958:Estradiol; C008958:polyestradiol phosphate