title: Differential effects of progestins on the circulating IGF-I system.
abstract: OBJECTIVE
  Circulating insulin-like growth factor-I (IGF-I) is mainly produced by the liver under GH stimulation and is influenced by nutrition and insulin. IGF-I bioavailability is regulated by interactions with specific binding proteins (IGFBPs). The objective of this paper is to review available data on modifications of the IGF-I system in menopausal women during HRT, with particular attention on the differential effects of progestins.
  
  
  METHODS
  All available reports on the effects of different forms of HRT have been taken into account.
  
  
  RESULTS
  Available data suggest that different kinds of HRT have different effect on the IGF-I system, depending on route of administration, oestrogen dose, basal IGF-I values and type of progestin. Oestrogen administration (oestrogen replacement therapy (ERT)) reduces circulating IGF-I mainly through a hepatocellular effect. The decrease is sharper when oral ERT is used (first pass hepatic effect) and in women with higher basal IGF-I levels. The progestins endowed with androgenic effects--the 19-nortestosterone derivatives and, to a lesser extent, medroxyprogesterone acetate (MPA)--tend to reverse the IGF-I decrease induced by oral oestrogens. In contrast, progestins devoid of androgen-like hepatocellular and metabolic actions (e.g. dydrogesterone) do not interfere with the IGF-I decrease induced by oral oestrogens. Data on the effect of ERT on IGFBP-3 level are not consistent. Oral ERT, via hepatocellular actions (amplified by the first pass hepatic effect) causes a two to three-fold increase in IGFBP-1 levels. Androgenic progestins oppose the IGFBP-1 increase induced by oral oestrogens. Data on the effect of ERT and different progestins on the level of free IGF-I are scant and inconsistent.
  
  
  CONCLUSIONS
  Even if some aspects need clarification, available data demonstrate that different progestins have differential effects on the circulating IGF-I system.
authors.affiliation: Unit of Endocrinological Gynecology, Ospedale Ginecologico Sant'Anna, Azienda Ospedaliera OIRM-S, Anna, Corso Spezia 60, 10126 Torino, Italy. ginendocrinol@oirmsantanna.piemonte.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Campagnoli
authors.forename: Chiara
authors.initials: C
authors.lastname: Abbà
authors.forename: Simona
authors.initials: S
authors.lastname: Ambroggio
authors.forename: Clementina
authors.initials: C
authors.lastname: Peris
mesh_terms: D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000378:metabolism / Q000494:pharmacology; D005260:Female; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D017698:Postmenopause; D011372:Progestins / Q000378:metabolism / Q000494:pharmacology*
chemical_list: D004967:Estrogens; D011372:Progestins; D007334:Insulin-Like Growth Factor I