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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Neuroendocrine Dysfunction in Women with Neurologic or Psychiatric Illness


GOAL
To provide physicians with current information on neuroendocrine dysfunction in women with neurologic or psychiatric illness, with a specific emphasis on epilepsy and bipolar disorder.

TARGET AUDIENCE
This activity is designed for neurologists and psychiatrists. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Discuss the interaction between epilepsy and the endocrine hormones.
  • Evaluate existing data on the relationship of neuroendocrine function and bipolar disorder.
  • Recognize polycystic ovary syndrome (PCOS) as a complex neuroendocrine disorder with multiple determinants.
  • Describe the possible relationship between PCOS and epilepsy, as well as PCOS and bipolar disorder.
  • Discuss the implications of neuroendocrine dysfunction in epilepsy and bipolar disorder for the treatment of women with these conditions.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.5 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

The estimated time to complete this educational activity: 1.5 hours.

Release date: August 15, 2003. Expiration date: August 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Abbott Laboratories.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. Program Directors and Participating Faculty reported the following:

PROGRAM DIRECTORS

    Gregory Krauss, MD
    Associate Professor
    Department of Neurology
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Krauss reports having no financial or advisory relationships with corporate organizations related to this activity.

    Howard A. Zacur, MD, PhD
    Theodore and Ingrid Baramki Professor of Reproductive Endocrinology
    Director, Division of Reproductive Endocrinology
    Department of Gynecology-Obstetrics
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr Zacur reports receiving grant and/or research support from Wyeth.

PARTICIPATING FACULTY

    Cynthia L. Harden, MD
    Associate Professor of Neurology
    Department of Neurology and Neuroscience
    New York-Presbyterian Hospital
    Weill Medical College of Cornell University
    New York, New York
    • Dr Harden reports receiving grant and/or research support from IVAX Pharmaceuticals and Pfizer, Inc; and receiving honoraria from GlaxoSmithKline and Ortho-McNeil Pharmaceutical, Inc.

    Natalie L. Rasgon, MD, PhD
    Associate Professor of Psychiatry
    Department of Psychiatry and Behavioral Sciences
    Associate Director
    Women's Wellness Program
    Stanford University School of Medicine
    Palo Alto, California
    • Dr Rasgon reports receiving grant and/or research support from Forest Laboratories, Inc; and serving as a consultant to and receiving honoraria from Forest Laboratories, Inc, Abbott Laboratories, Eli Lilly and Company, GlaxoSmithKline, Pfizer, Inc, and Wyeth.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity may contain reference(s) to unlabeled or unapproved uses of drugs or devices.

Faculty have indicated that they have not referenced unlabeled/unapproved uses of drugs or devices.

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Neuroendocrine Dysfunction in Women with Neurologic or Psychiatric Illness: Focus on Epilepsy and Bipolar Disorder
Howard A. Zacur, MD, PhD,* and Gregory Krauss, MD

It is well established that neuroendocrine function influences the development and course of neurologic and psychiatric illness. Neuropsychiatric illnesses are nearly always associated with neuroendocrine dysfunction, although the degree to which neuroendocrine abnormalities cause or result from neuropsychiatric pathology cannot yet be determined from the available data. The presence of neuroendocrine dysfunction influences the manifestations of neuropsychiatric illnesses and should be considered in developing disease-management strategies. This issue of Advanced Studies in Medicine discusses women's neuroendocrine dysfunction in 2 common neuropsychiatric disorders—epilepsy and bipolar disorder—and considers the implications of the data for the treatment of women with these conditions.

In her review article, Cynthia L. Harden, MD, considers the relationships between epilepsy and endocrine hormones in women and discusses the implications of these relationships for women's health. The interactions between epilepsy and endocrine hormones are manifest in catamenial seizures, frequent menstrual cycle abnormalities, altered fertility, and sexual dysfunction among women with epilepsy. Women with epilepsy have also been reported to be more likely to suffer from polycystic ovary syndrome (PCOS) compared with women in the general population. These neuroendocrine correlates of epilepsy may be explained by seizure-related disruption of hormones or brain regions mediating reproduction; antiepileptic drugs; and structural or functional central nervous system dysfunction associated with the disease of epilepsy (but not with seizure activity per se). Dr Harden notes that, by understanding the interactions between endocrine hormones and epilepsy throughout a woman's life span, physicians can better tailor management strategies to patients' individual needs.

Neuroendocrine dysfunction is common in bipolar disorder as in epilepsy. In her article, Natalie L. Rasgon, MD, PhD, reviews data from anatomic, functional, and clinical studies of neuroendocrine function in bipolar disorder. Many of the neuroendocrine abnormalities in bipolar depression are similar to those in unipolar depression, although the abnormalities are generally more marked in bipolar disorder in studies including patients with unipolar depression and bipolar depression. For example, bipolar disorder, like unipolar major depression, is characterized by a blunted response to the dexamethasone suppression test, but the frequency and magnitude of dexamethasone nonsuppression are generally greater in patients with bipolar disorder compared with unipolar major depression. Although neuroendocrine abnormalities are often qualitatively similar between bipolar disorder and unipolar major depression, bipolar disorder also is associated with unique characteristics. Some or all of these abnormalities may be attributed at least partly to central serotonergic dysfunction. Dr Rasgon notes that research has yet to elucidate the clinical significance of the neuroendocrine abnormalities in bipolar disorder and that the nature of the causal relationship between neuroendocrine abnormalities and mood pathology in bipolar disorder is not known. She concludes that, to improve the quality of care for patients, additional research is needed to define the clinical implications of specific aspects of neuroendocrine dysfunction in bipolar disorder.

In the article "Epidemiology, Clinical Manifestations, and Pathophysiology of Polycystic Ovary Syndrome," Howard A. Zacur, MD, PhD, assesses the data on PCOS, a common neuroendocrine abnormality in women in the general population as well as those with epilepsy or bipolar disorder. The cause of PCOS is unknown, and a cure for it has not been established. Dr Zacur notes that, although some clinicians have been concerned that antiepileptic medications may cause PCOS, no solid clinical evidence establishes that medications per se can cause PCOS. PCOS is associated with health risks, including cardiovascular disease, obesity, lipid abnormalities, and some cancers, but whether it is associated with serious long-term sequelae remains unknown. A complex and multifaceted condition, PCOS is difficult to diagnose and manage. Whereas most management strategies are directed at short-term improvement of problems, such as androgen excess or menstrual irregularity, long-term, comprehensive strategies that take into account PCOS correlates, such as obesity and insulin resistance, are necessary to optimize outcomes.

What are the implications of the data on neuroendocrine dysfunction for managing epilepsy or bipolar disorder in women? Drs Rasgon and Harden consider this question in their paper "Neuroendocrine Dysfunction in Women with Epilepsy or Bipolar Disorder: Implications for Patient Management." Neuroendocrine dysfunction in epilepsy and bipolar disorder can have serious short-term and long-term health consequences. Therefore, women with these conditions should be monitored carefully for signs or symptoms of neuroendocrine dysfunction so appropriate intervention can occur. Drs Rasgon and Harden note that, some healthcare providers' concerns to the contrary, no causal relationship between use of anticonvulsants and reproductive endocrine dysfunction in women with epilepsy or bipolar disorder is established based on available data, although a possible contributory role cannot be ruled out. The possible benefits of a change of antiepileptic or antipsychotic medication should be weighed carefully against the risks of adverse events and poor efficacy of alternative therapeutic options. Many aspects of neuroendocrine dysfunction can be controlled or prevented through lifestyle intervention and pharmacotherapy.

* Theodore and Ingrid Baramki Professor of Reproductive Endocrinology, and Director, Division of Reproductive Endocrinology, Department of Gynecology-Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. Associate Professor, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.