Glucocorticoid Suppression of Urinary Testosterone Excretion in Patients with Idiopathic Hirsutism

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Abstract
Twelve patients with idiopathic hirsutism were studied. Seven had irregular or absent menses. None had male pattern baldness, clitoral hypertrophy, palpably enlarged ovaries or a major defect in cortisol production. Urinary excretion of 17-ketosteroids (17-KS) was increased in 7 patients and urinary excretion of testosterone glucuronide (testosterone-G) was increased in 11 patients. Small doses of glucocorticoids were administered orally to all patients for 2-16 months. Three randomly assigned schedules of glueocorticoid administration were used. Glucocorticoid therapy caused the urinary excretion of 17-KS and testosterone-G to fall to normal or less than normal in all patients regardless of which schedule of drug administration was used. In 8 patients either menses became normal, hirsutism diminished or both occurred. One month after cessation of therapy most patients continued to excrete normal amounts of urinary 17-KS and testosterone-G. These data suggest that in some patients with idiopathic hirsutism the menstrual abnormalities and hirsutism are caused by excessive testosterone, and that the testosterone or its precursors are produced by an ACTH-responsive tissue.

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