TY - JOUR T1 - Beyond oestrogens: towards a broader evaluation of the hormone profile in pulmonary arterial hypertension JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01058-2018 VL - 51 IS - 6 SP - 1801058 AU - Jessica B. Badlam AU - Eric D. Austin Y1 - 2018/06/01 UR - http://erj.ersjournals.com/content/51/6/1801058.abstract N2 - For nearly all forms of group 1 pulmonary hypertension (pulmonary arterial hypertension; PAH), incident and prevalent patients are more likely to be female [1, 2]. The skew toward the female sex has long prompted an interest in the sex hormones as contributors to disease pathogenesis, with a particular interest in oestrogens. In 2010, Tofovic [3] employed the term “oestrogen paradox” based upon a perceived discrepancy: while PAH is a female-prevalent disease in humans, many (but not all) animal models demonstrate a protective effect of being female. However, over time, the intent of the “oestrogen paradox” has been modified to incorporate a growing body of human data concerning sex and PAH. In particular, the female predominance in PAH incidence is lower than the female predominance among prevalent cases; and, females appear to tolerate right ventricular (RV) stress and live longer than older males, if not all males [4–9]. While comprehensive data to determine why females may tolerate a hypertensive pulmonary vasculature better than males is lacking, growing information suggests that either baseline RV performance, and/or ability to adapt to stress with or without PAH therapy, may favour the female heart [10–14].Baird and colleagues contribute further evidence that the justification for sex-associated investigations in pulmonary arterial hypertension extend beyond oestrogen signalling. Evaluation of the entire steroid hormone milieu is crucial. http://ow.ly/7wbz30kp5VQ ER -