Therapie des Hirsutismus bei Frauen mit adrenalen Enzymdefekten der Steroidhormonbiosynthese: Vergleich von Dexamethason mit Cyproteronacetat

Abstract

In patients with adrenal hirsutism or enzyme deficiencies in steroidogenesis, elevated adrenal androgens could be normalized by dexamethasone. We were interested to see if dexamethasone would be as effective as cyproterone acetate in treating hirsutism in selected patients with adrenal pathogenesis. Therefore 28 patients with hirsutism of adrenal origin or enzyme deficiency were treated cyclically either with cyproterone acetate and ethinylestradiol (2 mg cyproterone acetate + 0.035 mg ethinyl-estradiol days 1-21, +10 mg cyproterone acetate days 1-15) (n = 15) or with 0.25-0.5 mg dexamethasone daily at 10 pm (n = 13). In the dexamethasone group there was a significant drop in dehydroepiandrosterone and dehydroepiandrosterone sulfate levels within 9 months, but there was a diminution in hirsutism in only four women (31%); in four out of seven menstrual irregularities decreased. In the cyproterone acetate group hirsutism diminished significantly in 66% (n = 10) without suppression of adrenal androgens. Weight gain occurred in a few cases in both groups; other side effects developed in 33% in the cyproterone acetate group. Preselection of patients with hirsutism is useful with respect to diagnosis; adrenal pathogenesis should not generally indicate dexamethasone treatment of hirsutism unless there is a desire for pregnancy, because cyproterone acetate is a more powerful agent in reducing hair growth.

Hiperplasia suprarrenal no clásica, características de laboratorio y respuesta al tratamiento. Estudio de cohorte

“…En varias revisiones se ha evidenciado la in luencia del IMC y la edad en los valores de andrógenos femeninos (27,28), por lo que quisimos correlacionar estas variables con cada uno de los paraclínicos evaluados durante el seguimiento (17-OH progesterona, testosterona y DHEA-S), y se encontró que los valores de testosterona y DHEA-S dependen solo de su valor inicial, no están in luenciados por la edad o el IMC; mientras que los valores de 17-OH progesterona están in luenciados por el IMC. Esto se debe tener en cuenta en pacientes con sobrepeso, cuyo curso de seguimiento bioquímico puede presentar un cambio más lento que en los pacientes con IMC normal.…”

Nonclassic congenital adrenal hyperplasia and the heterozygote carrier

“…The serum dehydroepiandrosterone and dehydroepiandrosterone-S concentrations decreased in the dexamethasone group but not in the CPA group. However, there was a 31% reduction in hirsutism in the dexamethasone group compared with 66% in the CPA group [43]. It is important to remember that glucocorticoid therapy can be associated with side effects even at the recommended doses including hypertension, weight gain, decreased bone mineral density [38].…”

Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India

“…There is no evidence for the use of glucocorticoids in women with adrenal[ 218 ] or unselected hyperandrogenism[ 219 ] and in women with idiopathic hirsutism[ 220 ] as compared to OCPs or antiandrogens. Glucocorticoids with OCPs are beneficial in women with nonclassical congenital adrenal hyperplasia (NCCAH) for prolonged remission.…”