Cyproterone AcetateVersusHydrocortisone Treatment in Late-Onset Adrenal Hyperplasia

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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 patients did not differ significantly. Excellent clinical evolution in terms of the regression of hirsutism was observed 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 .+-. 6.64 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.