A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer
A previously healthy 79-year-old female was referred to hematology for further evaluation of erythrocytosis. Two years earlier she had been diagnosed with ER/PR-positive ductal carcinoma of the breast and was receiving hormonal therapy with exemestane. No secondary cause of erythrocytosis was identi...
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doaj-f349286a99ed48738b904b99d512461e2020-11-24T23:15:00ZengHindawi LimitedCase Reports in Hematology2090-65602090-65792013-01-01201310.1155/2013/615189615189A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast CancerAbhinav Iyengar0Dawn Sheppard1Hematology Division, Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, CanadaHematology Division, Department of Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, CanadaA previously healthy 79-year-old female was referred to hematology for further evaluation of erythrocytosis. Two years earlier she had been diagnosed with ER/PR-positive ductal carcinoma of the breast and was receiving hormonal therapy with exemestane. No secondary cause of erythrocytosis was identified. Serum erythropoietin (EPO) level was normal, and molecular testing for the JAK2 V617F and exon 12 mutations was negative. A bone marrow biopsy showed a mild increase in erythropoiesis, and no spontaneous erythroid colonies were demonstrated. Erythrocytosis is common reason for referral to a hematologist. The myeloproliferative disorder, polycythemia vera, and the rare congenital polycythemias represent primary erythrocytosis. Common secondary causes include smoking, obstructive sleep apnea, and other pulmonary diseases. Erythrocytosis is well described with certain classes of drugs, including androgens. We hypothesize that exemestane contributed to the development of erythrocytosis in our patient. To our knowledge, erythrocytosis has not been previously described in association with aromatase inhibitors. These drugs prevent the conversion of androstenedione and testosterone to estrogen; thus the physiologic mechanisms may be similar to those responsible for erythrocytosis seen with exogenous androgens. These mechanisms are not well understood, but may include altered iron metabolism by a reduction in hepcidin levels.http://dx.doi.org/10.1155/2013/615189 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Abhinav Iyengar Dawn Sheppard |
spellingShingle |
Abhinav Iyengar Dawn Sheppard A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer Case Reports in Hematology |
author_facet |
Abhinav Iyengar Dawn Sheppard |
author_sort |
Abhinav Iyengar |
title |
A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer |
title_short |
A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer |
title_full |
A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer |
title_fullStr |
A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer |
title_full_unstemmed |
A Case of Erythrocytosis in a Patient Treated with an Aromatase Inhibitor for Breast Cancer |
title_sort |
case of erythrocytosis in a patient treated with an aromatase inhibitor for breast cancer |
publisher |
Hindawi Limited |
series |
Case Reports in Hematology |
issn |
2090-6560 2090-6579 |
publishDate |
2013-01-01 |
description |
A previously healthy 79-year-old female was referred to hematology for further evaluation of erythrocytosis. Two years earlier she had been diagnosed with ER/PR-positive ductal carcinoma of the breast and was receiving hormonal therapy with exemestane. No secondary cause of erythrocytosis was identified. Serum erythropoietin (EPO) level was normal, and molecular testing for the JAK2 V617F and exon 12 mutations was negative. A bone marrow biopsy showed a mild increase in erythropoiesis, and no spontaneous erythroid colonies were demonstrated. Erythrocytosis is common reason for referral to a hematologist. The myeloproliferative disorder, polycythemia vera, and the rare congenital polycythemias represent primary erythrocytosis. Common secondary causes include smoking, obstructive sleep apnea, and other pulmonary diseases. Erythrocytosis is well described with certain classes of drugs, including androgens. We hypothesize that exemestane contributed to the development of erythrocytosis in our patient. To our knowledge, erythrocytosis has not been previously described in association with aromatase inhibitors. These drugs prevent the conversion of androstenedione and testosterone to estrogen; thus the physiologic mechanisms may be similar to those responsible for erythrocytosis seen with exogenous androgens. These mechanisms are not well understood, but may include altered iron metabolism by a reduction in hepcidin levels. |
url |
http://dx.doi.org/10.1155/2013/615189 |
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