Cetrorelix suppression test to assess the source of androgen overproduction in postmenopausal hirsutism

Abstract

A 75-year-old woman presenting with recent onset hirsutism and severely elevated serum androgen levels was evaluated to assess the source of excessive androgen production. Commonly recommended hormonal stimulation and suppression tests, and the usually employed imaging techniques were nondiagnostic. In this report, we describe a new suppression test based on the use of the GnRH receptor antagonist, cetrorelix, to determine whether androgen production was LH-dependent. Cetrorelix, administered in a daily dose of 250 mg subcutaneously, suppressed serum LH within 24 h and reduced serum androgen levels to normal within 48-72 h, indicating that androgen overproduction was of ovarian origin. This diagnosis was confirmed by laparoscopic ovariectomy. Conclusion:The cetrorelix suppression test is a simple procedure that provides valuable information regarding the source of androgen excess in postmenopausal hirsutism.European Journal of Endocrinology 155 391-393

Hyperthécose ovarienne post-ménopausique

“…Le test de freinage aux antagonistes de la GnRH, en bloquant la sécrétion de LH et FSH de façon dose dépendante (250 mg de Cétrorelix par jour pendant 4 jours en sous-cutané permet d'obtenir une baisse de la LH en 24 heures et une diminution des androgènes en 48-72 heures jusqu'à des taux normaux), permet de confirmer l'origine ovarienne de la sécrétion d'androgène, mais ne permet pas de différentier tumeur virilisante et HTO [10,11].…”

“…Lorsque la chirurgie est contre-indiquée ou différée, l'utilisation d'un traitement par des analogues de la GnRH peut être envisagé avec une importance et une durée de suppression dose dépendante. Ce traitement est très coûteux et son efficacité à long terme reste à évaluer [10].…”

Use of cetrorelix in the investigation of testosterone excess in a postmenopausal woman

“…They are usually benign, unilateral and mainly occur in peri or postmenopausal women. Approximately 75% are associated with signs of hyperandrogenism, although occasionally patients may have signs of hyperoestrogenism, such as postmenopausal bleeding, either alone or in addition to virilisation 2 3 9…”

“…Using information from case reports,1 2 we established a protocol for cetrorelix administration which would allow investigation on an outpatient basis.…”

“…A few case reports describe the use of cetrorelix for this purpose, using protocols involving frequent blood sampling over a 2–4-day period 1 2. Based on information from these case reports, we established a protocol for cetrorelix administration which would allow investigation on an outpatient basis.…”