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Geburtshilfe Frauenheilkd 2003; 63(3): R41-R64
DOI: 10.1055/s-2004-817985
GebFra-Refresher

Georg Thieme Verlag Stuttgart · New York

Der klinische Einsatz von GnRH-Analoga in der Gynäkologie

A. Rody1 , S. Kissler1 , R. R. Greb2 , M. Kaufmann1 , L. Kiesel2
  • 1Frankfurt
  • 2Münster
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Publication History

Publication Date:
02 April 2003 (online)

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Die Herstellung synthetischer Gonadotropin-Releasing-Hormon-(GnRH-) Agonisten

GnRH-Agonisten steigern kurz die Gonadotropinauschüttung, bevor Hormonsynthese und -ausschüttung abfallen (desensitization).
wurde ursprünglich verfolgt, um über potentere Substanzen als natives GnRH für die Stimulationstherapie zu verfügen. Bei der Applikation fiel jedoch zunächst eine kurze Periode gesteigerter Gonadotropinausschüttung auf und erst nach längerer Gabe kam es zu einem Abfall der Hormonsynthese und -ausschüttung. Diese paradoxe Wirkungsweise, auch als „desensitization“ bezeichnet, wird für die Therapie zahlreicher sexualhormonabhängiger Erkrankungen genutzt. Durch die Einführung von GnRH-Antagonisten

GnRH-Antagonisten blockieren ohne Verzögerung die Gonadotropinausschüttung.
in die klinische Routine kann allerdings eine sofortige Blockade der Gonadotropinausschüttung erzielt werden. Der Einsatz von GnRH-Analoga stellt insbesondere in der Therapie hormonabhängiger gutartiger (z. B. Leiomyome des Uterus, dysfunktionelle Blutungsstörungen, Endometriose)

Hauptindikationen für GnRH-Analoga: hormonabhängige gutartige Tumoren, maligne Tumoren, COH.
und maligner Erkrankungen (Mamma-, Ovarial- und Endometriumkarzinom) eine wesentliche Ergänzung dar. Des Weiteren fanden die GnRH-Analoga durch die Inhibition der hypophysären Gonadotropinausschüttung bei der kontrollierten ovariellen Überstimulation (COH) Eingang in die Reproduktionsmedizin. Allerdings limitieren der Östrogenentzug mit den entsprechenden Begleitsymptomen und die Kosten den langfristigen Einsatz dieser Substanzen. Im Folgenden soll das Spektrum des therapeutischen Einsatzes synthetischer GnRH-Analoga bei gynäkologischen Erkrankungen dargestellt werden.

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