Four hundred fifty-two of 902 surveys were returned for a 50% response rate. Eighty-two percent of respondents were placed on (adjuvant hormonal therapy) some form of estrogen-blocking therapy. Fifty-four percent of these were placed on tamoxifen and 46% on an AI. The most troublesome symptoms for tamoxifen and AI users, respectively, included hot flashes (35%/30%), weight gain (14%/15%), insomnia (17%/17%), and joint aches (12%/23%, P = .002). Thirty-nine percent of TAM users and 46% of AI users were taking medications to control their symptoms. Fifty percent of TAM users and 39% of AI users took vitamin E to help control hot flashes. Forty-two percent of TAM users versus 32% of AI users took Advil (Wyeth, Richmond, VA) for muscle/joint aches; % of AI users switched medication to improve symptoms as compared with only 37% of tamoxifen users (P = .015). The average cost of medications to control side effects for both tamoxifen and AI users was $ per month.
p450 aromatase (p450aro), involved in androgen to estrogen conversion, is encoded by the cyp19 gene. p450aro c655g> a mutation described in heterozygous form in a girl and in homozygous form in an adult male with p450aro deficiency results in an aberrant splicing due to disruption of a donor splice site. a truncated inactive protein would be expected if intron5 is retained. surprisingly, the girl described with this mutation showed spontaneous breast development and pubertal estradiol (e2) levels suggesting residual p450aro activity (aa). formerly, we postulate the in frame e5 skipping as a consequence of this mutation generating a protein with some degree of activity. when p450aro mrna expression was analysed from patient's lymphocytes, an aberrant spliced mrna lacking e5 (-e5mrna) was detected, suggesting an association between e5 skipping and the presence of the mutation. splicing assays in y1 cells confirmed this association. -ex5 cdna expression in y1 cells resulted in an inactive protein that could not explain patient's phenotype. exon 5 might be predicted as a poorly defined exon suggesting a susceptibility to splicing mutations and physiological alternative splicing (as) events. therefore, -ex5mrna was assessed as a natural occurring alternative transcript in normal human steroidogenic tissues. as p450aro -e5mrna expression was detected in human term placenta, prepubertal testis and prepubertal adrenal, we might speculate that as of p450aro coding region would occur in humans and would be involved in the complex aa regulation. furthermore, tissue specific regulation of as might suggest low expression of +e5mrna from the c655g> a allele explaining residual aa evidenced in the affected girl.
Since alpha-glucosidase inhibitors prevent the degradation of complex carbohydrates into glucose, the carbohydrates will remain in the intestine. In the colon , bacteria will digest the complex carbohydrates, thereby causing gastrointestinal side effects such as flatulence and diarrhea . Since these effects are dose-related, it is generally advised to start with a low dose and gradually increase the dose to the desired amount. Pneumatosis cystoides intestinalis is another reported side effect. [ citation needed ] If a patient using an alpha-glucosidase inhibitor suffers from an episode of hypoglycemia , the patient should eat something containing monosaccharides, such as glucose tablets. Since the drug will prevent the digestion of polysaccharides (or non-monosaccharides), non-monosaccharide foods may not effectively reverse a hypoglycemic episode in a patient taking an alpha-glucosidase inhibitor. [ citation needed ]