Speciality
Spotlight

 




 


Obstetric & Gynaecology


 

 




Hirsutism

       

  • Y Sahin, S Dilber, and F Kelestimur (Erciyes University Medical School)

    Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism

    Fert.& Ster.vol.75(3), March 2001, pg. 496-500

      

    Objective: To compare the clinical efficacy and safety of the combination of Diane 35 (2mg of cyproterone acetate, and 35 mg of ethinyl estradiol) plus finasteride (5mg), and Diane 35 alone in the treatment of
    hirsutism.

      

    Design: Prospective randomised clinical study.

      

    Intervention(s): For 1 year, group 1 patients (n=20) were treated with Diane 35 alone (2 mg of cyproterone acetate and 35 mg of ethinyl estradiol) daily on days 5 to 25 of the menstrual cycle and group 2 patients (n=20) with Diane 35 plus finasteride (5mg daily).

      

    Main Outcome Measure(s): Hirsutism was graded at 6-month intervals using the Ferriman-Gallwey method. The basal hormone levels of total and free testosterone (T), androstenedione, DHEAS and sex-hormone binding globulin (SHBG) were measured by radioimmunoassay before the study. Total T, free T, SHBG, and DHEAS were also measured at 6-month intervals for 1 year. Multiscreen blood chemistry and side effects were evaluated during the treatment.

      

    Discussion: Cyproterone acetate is a powerful progrestogen that also acts as an antiandrogen at target sites. CPA is generally used in combination with oral ethinyl estradiol. The beneficial effect of CPA plus ethinyl estradiol seems to be related to the decrease in the plasma levels of total T and free T, A, DHT, and 3a-diol glucuronide (3a-diol G), and to the increase in SHBG concentrations.

      

    Finasteride is a 5a – reductase inhibitor that inhibits the conversion of T to DHT, the active androgen in the hair
    folicle.

      

    Finasteride blocks the conversion of testosterone to the more potent DHT by binding to the enzyme 5a- reductase type 2 (found in genital skin and the prostate in the male) than type 1 (nongenital, scalp), but the specificity of the two isoenzymes is incomplete. At present, 5mg is recommended as the daily dose for women, as no added effectiveness has been demonstrated at higher doses.

      

    Despite the widespread use of CPA and finasteride in the treatment of hirsutism, their combination has not been used.

      

    In conclusion, the present data demonstrate that Diane 35 alone and the Diane 35 plus finasteride (5mg) combination are effective and safe for the treatment of hirsutism. The percentage change in the Ferriman-Gallwey score at 12 months from baseline level was higher in the patients treated with Diane 35 alone. Therefore, the addition of finasteride to Diane 35 has a synergistic effect on the hirsutism
    score.

        

  • Zoe Efstathiadou and Agathocles Tsatsoulis

    Long-term remission of ovarian hyperandrogenism after short-term treatment with a gonadotroin-releasing hormone agonist.

    Fert.& Ster. Vol.75(1),Jan.2001, pg.59-62

     

    Objective: To assess the long-term effects of GnRH agonist (GnRH-a) therapy in a patient with benign ovarian hyperandrogenism.

     

    Setting: University Hospital endocrine outpatient’s clinic.

     

    Patients: A 55-year old postmenopausal woman with hirsutism and virilization of ovarian origin.

     

    Interventions: Treatment with a course of GnRH-a (triptorelin 3.75mg IM every 28 days for 4 months). Follow up for 3 years.

     

    Main Outcome Measures: Serum gonadotropin and androgen levels, clinical assessment using the Ferriman-Gallwey score, and assessment of ovarian morphology by ultrasonography.

     

    Results: Administration of triptorelin resulted in suppression of serum testosterone and gonadotropin values and relief of the hyperandrogenic symptoms. Upon discontinuation of treatment, the patient’s serum gonadotropin levels returned to the postmenopausal range, but he testosterone levels remained normal and the patient was asymptomatic for an observation period of 3 years.

     

    Conclusions: This case is the first example of long-term remission of ovarian hyperandrogenism in a postmenopausal woman, after short-term treatment with GnRH-a. This supports the view that GnRH-a therapy could be used, even in short courses, for the long-term suppression of benign ovarian
    hyperandrogenism.

       

      



 

 

Speciality Spotlight

 

 

Hirsutism
       

  • Y Sahin, S Dilber, and F Kelestimur (Erciyes University Medical School)
    Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism
    Fert.& Ster.vol.75(3), March 2001, pg. 496-500
      
    Objective: To compare the clinical efficacy and safety of the combination of Diane 35 (2mg of cyproterone acetate, and 35 mg of ethinyl estradiol) plus finasteride (5mg), and Diane 35 alone in the treatment of hirsutism.
      
    Design: Prospective randomised clinical study.
      
    Intervention(s): For 1 year, group 1 patients (n=20) were treated with Diane 35 alone (2 mg of cyproterone acetate and 35 mg of ethinyl estradiol) daily on days 5 to 25 of the menstrual cycle and group 2 patients (n=20) with Diane 35 plus finasteride (5mg daily).
      
    Main Outcome Measure(s): Hirsutism was graded at 6-month intervals using the Ferriman-Gallwey method. The basal hormone levels of total and free testosterone (T), androstenedione, DHEAS and sex-hormone binding globulin (SHBG) were measured by radioimmunoassay before the study. Total T, free T, SHBG, and DHEAS were also measured at 6-month intervals for 1 year. Multiscreen blood chemistry and side effects were evaluated during the treatment.
      
    Discussion: Cyproterone acetate is a powerful progrestogen that also acts as an antiandrogen at target sites. CPA is generally used in combination with oral ethinyl estradiol. The beneficial effect of CPA plus ethinyl estradiol seems to be related to the decrease in the plasma levels of total T and free T, A, DHT, and 3a-diol glucuronide (3a-diol G), and to the increase in SHBG concentrations.
      
    Finasteride is a 5a – reductase inhibitor that inhibits the conversion of T to DHT, the active androgen in the hair folicle.
      
    Finasteride blocks the conversion of testosterone to the more potent DHT by binding to the enzyme 5a- reductase type 2 (found in genital skin and the prostate in the male) than type 1 (nongenital, scalp), but the specificity of the two isoenzymes is incomplete. At present, 5mg is recommended as the daily dose for women, as no added effectiveness has been demonstrated at higher doses.
      
    Despite the widespread use of CPA and finasteride in the treatment of hirsutism, their combination has not been used.
      
    In conclusion, the present data demonstrate that Diane 35 alone and the Diane 35 plus finasteride (5mg) combination are effective and safe for the treatment of hirsutism. The percentage change in the Ferriman-Gallwey score at 12 months from baseline level was higher in the patients treated with Diane 35 alone. Therefore, the addition of finasteride to Diane 35 has a synergistic effect on the hirsutism score.
        

  • Zoe Efstathiadou and Agathocles Tsatsoulis
    Long-term remission of ovarian hyperandrogenism after short-term treatment with a gonadotroin-releasing hormone agonist.
    Fert.& Ster. Vol.75(1),Jan.2001, pg.59-62
     
    Objective: To assess the long-term effects of GnRH agonist (GnRH-a) therapy in a patient with benign ovarian hyperandrogenism.
     
    Setting: University Hospital endocrine outpatient’s clinic.
     
    Patients: A 55-year old postmenopausal woman with hirsutism and virilization of ovarian origin.
     
    Interventions: Treatment with a course of GnRH-a (triptorelin 3.75mg IM every 28 days for 4 months). Follow up for 3 years.
     
    Main Outcome Measures: Serum gonadotropin and androgen levels, clinical assessment using the Ferriman-Gallwey score, and assessment of ovarian morphology by ultrasonography.
     
    Results: Administration of triptorelin resulted in suppression of serum testosterone and gonadotropin values and relief of the hyperandrogenic symptoms. Upon discontinuation of treatment, the patient’s serum gonadotropin levels returned to the postmenopausal range, but he testosterone levels remained normal and the patient was asymptomatic for an observation period of 3 years.
     
    Conclusions: This case is the first example of long-term remission of ovarian hyperandrogenism in a postmenopausal woman, after short-term treatment with GnRH-a. This supports the view that GnRH-a therapy could be used, even in short courses, for the long-term suppression of benign ovarian hyperandrogenism.
       

      

 

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