Gynecology Book

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Diethylstilbestrol ExposureAka: Diethylstilbestrol, DES, DES Exposure

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  1. Background
    1. DES is an oral synthetic nonsteroidal Estrogen
    2. DES was prescribed in pregnanc
      1. Used to improve pregnancy outcomes
      2. Later studies did not support any benefit for DES
      3. Used in U.S. 1938 to 1971
      4. Used in Europe until 1980's
    3. Now DES is only used in advanced Prostate Cancer
  2. Associated conditions to DES exposure (highly correlated)
    1. Associated with in utero exposure to DES
    2. Highest risk were patients exposed in first trimester
    3. Carcinoma
      1. Vaginal clear cell adenocarcinoma
        1. Peak onset age 17 to 22 years
        2. Possibly second peak at post-Menopause
      2. Breast Cancer (same risk as Hormone Replacement)
    4. Gynecologic tract abnormalities
      1. T-shaped uterus
      2. Adenosis
      3. Cervical abnormalities (e.g. pseudopolyp)
    5. Risks in men exposed in utero to DES
      1. Undescended Testes
      2. Small Testes
      3. Possible Prostate Cancer risk
      4. Possible Testicular Cancer risk
  3. Surveillance of women with in utero DES exposure history
    1. Colposcopy at first Pap Smear
      1. Repeat annually (at minimum) for abnormalities
      2. Routine Colposcopy not needed if normal
    2. Annual Pap Smear, four quadrants and pelvic exam
      1. Sample cells with brush from four vaginal quadrants
      2. Routine Pap Smear
      3. Bimanual exam
    3. Pregnancy management
      1. Discuss higher risk of Miscarriage and poor outcomes
      2. Refer to obstetrics if pregnant
  4. References
    1. Giusti (1995) Ann Intern Med 122:778
    2. Schrager (2004) Am Fam Physician 69:2395

Diethylstilbestrol (C0012203)

Definition (MSH)A synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. It was also used formerly as a growth promoter in animals. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985), diethylstilbestrol has been listed as a known carcinogen. (Merck, 11th ed)
Definition (CSP)synthetic nonsteroidal estrogen used in the treatment of menopausal, postmenopausal, and other disorders sensitive to estrogens; an epigenetic carcinogen.
Definition (NCI)(dye-ETH-ul-stil-BES-trol) DES. A synthetic hormone that was prescribed from the early 1940s until 1971 to help women with complications of pregnancy. DES has been linked to an increased risk of clear cell carcinoma of the vagina in daughters of women who used DES. DES may also increase the risk of breast cancer in women who used DES.
Definition (PDQ)DES; the acronym for diethylstilbestrol, a synthetic, nonsteroidal form of estrogen. A well-known teratogen and carcinogen, DES inhibits the hypothalamic-pituitary-gonadal axis, thereby blocking the testicular synthesis of testosterone, lowering plasma testosterone, and inducing a chemical castration. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43081&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=43081&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C433" NCI Thesaurus)
Definition (NCI)A synthetic, nonsteroidal form of estrogen. A well-known teratogen and carcinogen, diethylstilbestrol inhibits the hypothalamic-pituitary-gonadal axis, thereby blocking the testicular synthesis of testosterone, lowering plasma testosterone, and inducing a chemical castration.
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131)
MSHD004054
EnglishDES, DES preparation, Diethylstilbenediol, Diethylstilbestrol, Diethylstilbestrol preparation, Diethylstilbestrolum, Diethylstilboestrol, Diethylstilboestrol preparation, Palestrol, Sinestrol, Stilbene Estrogen, Stilbestrol, Stilbestrol preparation, Stilboestrol, Stilboestrol Dipropionate, Stilboestrol preparation
Spanishdietilestilbestrol, preparado de DES, preparado de dietilestilbestrol, preparado de estilbestrol
Parent ConceptsContraceptive Agents, Female (C0009873), Estrogens, Synthetic (C0014941), Stilbenes (C0038333), Teratogens (C0039536), Estrogens, Non-Steroidal (C0014940), Estrogens (C0014939), Antineoplastic Agents (C0003392), Diethylstilbestrol (C0012203)
SourcesCSP, LCH, LNC, MSH, MTH, MTHFDA, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


DES EXPOSURE (C0149666)

ConceptsFinding (T033)
EnglishDES EXPOSURE
SourcesCOSTAR
Derived from the NIH UMLS (Unified Medical Language System)



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