Use of Corticosteroids in Infertility Associated with Hirsuties and Oligomenorrhoea

Abstract

ADRENAL PSEUDOHERMAPHRODITISMBMJouT=AL_ hirsutism seemed to argue against the latter, though from other points of view this seemed to be the most probable diagnosis. The findings on investigation soon settled the point: the very high 17-KS and 17-KGS and the elevated P'triol and P'diol pointed convincingly to adrenal hyperfunction, while the prompt response to prednisone suppression ruled against an adrenal tumour. The sex chromatin indicated female genetic sex, and laparotomy confirmed the existence of normal internal genitalia. Mr. Mlatthews found the construction of an effective vagina more straightforward than had been expected; incision of the perineum, dilatation, and the insertion of an indwelling dilator were all that was required and grafting was not necessary. It was an advantage that the patient married soon after, and fortunate that she was able to establish normal coitus with little difficulty. The basis for the treatment of adrenal hyperplasia with suppressive corticosteroids, following the pioneer work of Lawson Wilkins and his colleagues, is now too well known to require discussion. It is, however, very striking that, even though the patient was 24 years old, her menarche occurred only 36 days after starting definitive prednisone therapy and fertility was established soon afterwards. This dramatic response in patients with severe congenital adrenal hyperplasia is uniformly seen and is, of course, extremely gratifying.The smooth course of pregnancy, with only a minimal rise in 17-KS excretion, necessitating no change in prednisone dosage other than the prophylactic increase at the time of delivery, was perhaps rather unexpected though none the less pleasing. In the same way the good recovery from the caesarean section, the birth of a healthy baby, the establishment of lactation, and, more recently, the re-establishment of menstruation, have all been a source of great satisfaction. Summary

Treatment of Hirsutism by Adrenal and Ovarian Suppression

“…There have been reports of the value of adrenal suppression (1). The effect on hair growth is usually disappointing (2) although menstrual regularity may be restored and infertility corrected (3). There are a few reports on the results of ovarian suppression in the treatment of hirsutism (4)(5)(6) and it has been suggested that the hair growth may be appreciably reduced in some patients.…”