Cyproterone Acetate Versus Hydrocortisone Treatment in Late-Onset Adrenal Hyperplasia
Abstract
Thirty late-onset adrenal hyperplasia patients consulting for isolated hirsutism were randomly divided into two groups; group 1 (n = 16) was treated with hydrocortisone in order to suppress androgen adrenal secretion, and group 2 (n = 14) received cyproterone acetate (CPA) antiandrogen therapy to inhibit peripheral androgen activity. The clinical and hormonal effects of each type of treatment were evaluated. Before treatment, the clinical and hormonal profiles of the two patient groups did not differ significantly. Excellent clinical evolution in terms of the regression of hirsutism was observed in the CPA-treated patients (54% decrease in the clinical score in 1 yr), in contrast with the slight decrease in hirsutism (26%) after hydrocortisone treatment. In hydrocortisone-treated patients, plasma androgen decreased to normal levels: testosterone from 3.05 +/- 1.45 to 1.46 +/- 0.42 nmol/L and delta 4-androstenedione from 13.6 +/- 4.1 to 6.33 +/- 1.47 nmol/L. Conversely, in CPA-treated patients, only a slight decrease in testosterone from 2.98 +/- 1.98 to 2.29 +/- 0.64 nmol/L and in delta 4-androstenedione from 12.9 +/- 5.9 to 9.86 +/- 2.23 nmol/L was observed. This slight decrease in plasma androgens contrasts with the rapid clinical improvement after CPA. These results emphasize the importance of peripheral receptivity to androgens in the clinical expression of hyperandrogenism. Moreover, they indicate that peripheral antiandrogen therapy may be more appropriate in late-onset adrenal hyperplasia patients than conventional adrenal inhibition using cortisone therapy.
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Spironolactone, flutamide and finasteride can be used to treat hirsutism, acne and androgenic alopecia but are teratogenic and not approved for this use.
“Spironolactone, flutamide and finasteride can be used to treat hirsutism (433), acne and androgenic alopecia (436) but are teratogenic and not approved for this use.”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [433]
Hirsutism is the most prevalent symptom in women with NC CAH, but also the most difficult to treat.
“Hirsutism is the most prevalent symptom in women with NC CAH, but also the most difficult to treat (433).”
From Congenital Adrenal Hyperplasia—Current Insights in Pathophysiology, Diagnostics, and Management (2022) · cites this paper as [433]
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Self-citation
- Authors
- SPRITZER, P., BILLAUD, L., THALABARD, J.-C., BIRMAN, P., MOWSZOWICZ, I., RAUX-DEMAY, M.-C., CLAIR, F., KUTTENN, F., & MAUVAIS-JARVIS, P.
- Affiliations
- Hôpital Necker-Enfants Malades (FR)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1990-03
- Volume
- 70
- Issue
- 3
- Pages
- 642-646
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2148272405
- Cited by
- 146
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 4 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 2
- FWCI
- 2.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Keywords
- hirsutism, cyproterone acetate, cortisol, antiandrogen therapy, hyperandrogenism, testosterone, Δ4-androstenedione
- MeSH terms
- Adolescent, Adrenal Hyperplasia, Congenital, Adult, Androstenedione, Cyproterone, Estradiol, Female, Hirsutism, Humans, Hydrocortisone, Testosterone, Cyproterone Acetate
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