Endocrine Abstracts

A 29 year old woman with multiply-relapsed Hodgkin’s lymphoma became amenorrhoeic with vasomotor menopausal symptoms following multiple cycles of chemotherapy. Subsequent biochemistry confirmed primary gonadal failure (LH 30.7 U/L, FSH 49.9 U/L, oestradiol <70 pmol/L). Following allogeneic bone marrow transplantation she developed severe haemolytic anaemia and thrombocytopenia. This was resistant to standard therapies, including methylprednisolone, mycophenolate mofetil, plasma exchange and splenectomy, thus she was commenced on danazol 100 mg qds with good effect. On subsequent presentation to the menopause clinic for consideration of hormone replacement, she was found to have an elevated oestradiol level of 1356 pmol/L, yet remained amenorrhoeic and symptomatic of oestrogen deficiency. Gonadotrophins were reduced from previous levels by danazol, but remained consistent with hypogonadism (LH 11 U/L, FSH 25.5 U/L). On further monitoring, it was noted that oestradiol levels fell towards menopausal values as danazol was withdrawn. Danazol is a synthetic androgen which inhibits pituitary gonadotrophin release, thereby suppressing ovulation and ovarian steroidogenesis - underlying its classical use in endometriosis. It also has a steroid-sparing role in various autoimmune haematological disorders, although the mechanism here is undefined. It has recently been reported that danazol and its metabolites may cross-react with oestradiol immuno-assays. This was most pronounced with the Abbott ARCHITECT system used in our centre, and explains the dose-dependent rise in oestradiol in this patient whilst taking danazol. However, this case illustrates a more significant rise in oestradiol than previous publications which report a rise of <183.5 pmol/L (<50 pg/ml). We therefore advise caution in interpreting oestradiol assays in patients taking danazol, and propose that liquid chromatography-mass spectrometry techniques may give a more reliable measurement in this group.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.