High doses of a widely-used drug used in the hormonal treatment of conditions such as excessive hair growth, early puberty, prostate cancer, are linked to an increased risk of meningioma -- the most common type of benign brain tumor, finds a new study of over 8-million patients.
Typically, slow-growing, meningiomas are benign tumors, which are often revealed incidentally by imaging but can cause significant disability due to compressing or squeezing the adjacent brain, nerves and vessels and pressure effects within a fixed cranial vault.
Recent studies have reported an association between the growth of meningiomas and hormonal treatments, particularly prolonged and high dose use of the drug cyproterone acetate (CPA).
High doses of cyproterone acetate (> 50 mg/day) is usually prescribed to male patients with inoperable prostate cancer, a condition which leads to excessive hair growth known as hirsutism, or male-to-female transsexual hormonal therapy. Lower doses (2-10 mg/day) of the drug are typically used in combination with estradiol to treat androgen-associated alopecia or female seborrhea.
Given the drug's widespread use, researchers at the Universities of Bristol, Cambridge and the National University of Singapore, conducted a systematic review and meta-analysis study using four studies comprising a sample of 8,132,348 patients, to assess the evidence of the association between cyproterone acetate and incidence of meningiomas.
The sample included 165,988 patients who were identified as taking cyproterone acetate at varying dose amounts. Using this data, the team analyzed the occurrence of meningioma in patients using high versus low dose cyproterone acetate and found a significant association between high dose usage and increased risk of meningioma. However, this association was not found with low doses.
Keng Siang Lee, a medical student and the study's lead author from Bristol Medical School at the University of Bristol, said: "The cause of meningiomas is controversial but there is strong evidence to suggest a plausible role for sex hormones in the onset of meningioma. We know it has a predilection for females especially after puberty. Furthermore, fluctuations in meningioma growth during the menstrual cycle, pregnancy, and breastfeeding have also been well-documented. We are also aware of the well-characterized distribution of progesterone, estrogen, and androgen receptors in certain meningiomas located at the base of the skull.
"In light of these results, prescription of high-dose cyproterone acetate, especially for off label indications, should be considered carefully. Additionally, we suggest that routine screening and meningioma surveillance by brain MRI offered to patients prescribed with cyproterone acetate is likely a reasonable clinical consideration if given at high doses for long periods of time.
"However, our study underscores the current limited evidence about the risk of intracranial meningioma associated with low dose cyproterone acetate. It is still unknown whether or not cyproterone acetate below a certain threshold may be completely safe in terms of the risk of meningioma. The results obtained herein suggest the necessity for further clinical research on intracranial meningioma associated with cyproterone acetate."
5 Important Hormones
- Insulin
The fat-storage hormone, insulin, is released by your pancreas and regulates many of your metabolic processes. This hormone makes it possible for your organs, liver, and fat to absorb glucose. If your body doesn’t generate enough insulin or if it isn’t using it well, blood sugar accumulates and can set you up for diabetes.
- Melatonin
The pineal gland in your brain produces melatonin, which is instrumental in your sleep/wake cycles and your internal body clock. As the light of day becomes the dark of night, your brain amps up your melatonin levels to prepare you for sleep. Interruptions to natural darkness impair melatonin levels and sleep quality. For instance, late-night exposure to the blue light of screens can interrupt natural sleep patterns.
- Estrogen
Also known as the female sex hormone, estrogen is released by a woman’s ovaries. It’s a crucial element of the development of breasts, pubic hair, and the widening of hips. In addition to regulating a female’s periods, estrogen is also involved in bone formation, blood clotting, and the health of your skin and nails. If you are depleted in estrogen, you may have low moods or depression. When estrogen levels fluctuate, as they do during menopause, you may experience hot flashes, low libido, and weight gain.
- Testosterone
Testosterone is a sex hormone that’s manufactured in male testicles and female ovaries. It’s most often associated with sex drive, but is also closely associated with muscle and bone mass and the distribution of fat cells. Low levels of testosterone cause erectile dysfunction, low sex drive, decreased semen production, loss of muscle, and low bone density.
- Cortisol
Cortisol is the stress hormone. It’s a natural alert system to let you know when you’re under duress. While it’s helpful when you need to be aware of imminent danger, consistently high cortisol levels can lead to anxiety, weight gain, migraines, heart problems, irritability, brain fog, and sleep disturbances.
