Dexamethasone and spironolactone in the treatment of non-tumorous hyperandrogenism

Preželj, Janez; Kocijancic, A; Andolsek, L

doi:10.3109/09513598909152467

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…The addition of glucocorticoids to antiandrogen therapy does not appear to improve the magnitude of the decrease in hirsutism scores. In two trials of spironolactone plus dexamethasone vs. spironolactone alone, the decrease in hirsutism scores after therapy was reported to be similar in the combined and spironolactone-only treated subgroups, whereas the decrease in androgen levels was variable (72,74,78,79). However, glucocorticoid therapy may have a longer-term effect on hirsutism.…”

Section: Addition Of Glucocorticoids To Antiandrogensmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

Martin

Chang

Ehrmann

et al. 2008

The Journal of Clinical Endocrinology & Metabolism

376

249

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We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or clitoromegaly. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photoepilation.

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Section: Addition Of Glucocorticoids To Antiandrogensmentioning

confidence: 99%

“…Most studies have been conducted in unselected hyperandrogenic women whose chief complaint was hirsutism and in women with idiopathic hirsutism (72)(73)(74)(77)(78)(79). Two trials also included women with glucocorticoid-sensitive hyperandrogenic hirsutism, i.e.…”

Section: Other Studies Of Glucocorticoids In Unselected Hyperandrogenmentioning

confidence: 99%

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

Martin

Chang

Ehrmann

et al. 2008

The Journal of Clinical Endocrinology & Metabolism

376

249

View full text Add to dashboard Cite

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“…Search results are shown in Figure . We included 157 studies comprising 10 550 women . The mean age varied between 15 years and 46 years, and the overall mean was 25·4 years.…”

Section: Resultsmentioning

confidence: 99%

“…One‐third of the studies (48 of 157) reported data that could not be further analysed (Table S2; see Supporting Information) . The remaining 109 studies covered 133 comparisons (Table S3; see Supporting Information) . Although the minimal important difference for the FG score has not been established, a change score exceeding 7 was considered to be clinically important.…”

Section: Resultsmentioning

confidence: 99%

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Zuuren

Fedorowicz

2016

Br J Dermatol

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Hirsutism is a common disorder with a major impact on quality of life. The most frequent cause is polycystic ovary syndrome. Effects of interventions (except laser and light-based therapies) were evaluated, including Grading of Recommendations Assessment, Development and Evaluation assessments. Searches included Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase and five trials registers to June 2014. We included 157 randomized controlled trials (RCTs) with 10 550 participants. The majority were assessed as having a 'high risk' of bias (123 of 157). The quality of evidence was rated moderate to very low for most outcomes. Pooled data for an oral contraceptive (OCP) (ethinyl oestradiol and cyproterone acetate) compared with another OCP (ethinyl oestradiol and desogestrel) demonstrated that both treatments were effective in reducing Ferriman-Gallwey scores, but the mean difference (MD) was not statistically significant [-1·84, 95% confidence interval (CI): -3·86-0·18]. Flutamide was more effective than placebo in two studies (MD -7·60, 95% CI: -10·53 to -4·67 and MD -7·20, 95% CI: -10·15 to -4·25), as was spironolactone (MD -7·69, 95% CI: -10·12 to -5·26). Spironolactone appeared to be as effective as flutamide (two studies) and finasteride (two studies). However, finasteride and the gonadotropin-releasing analogues showed discrepant results in several RCTs. Metformin was ineffective. Cyproterone acetate combined with OCPs demonstrated greater reductions in Ferriman-Gallwey scores. Lifestyle interventions reduced body mass index but did not show improvement in hirsutism, and although cosmetic measures are frequently used, no RCTs investigating cosmetic treatments were identified. RCTs investigating OCPs in combination with antiandrogens or finasteride vs. OCP alone, or the different antiandrogens and 5α-reductase inhibitors are warranted.

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“…Glucocorticoids with OCPs are beneficial in women with nonclassical congenital adrenal hyperplasia (NCCAH) for prolonged remission. [ 221 ]…”

Section: Hoice Of O Ral C mentioning

confidence: 99%

Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India

Patil¹

2018

J Hum Reprod Sci

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Objective:To provide consensus recommendations for health-care providers on the use of oral contraceptive pills (OCPs) in polycystic ovarian syndrome (PCOS) women in India.Participants:Extensive deliberations, discussions, and brainstorming were done with different fraternities (specialists) being involved. These included endocrinologists, gynecologists, reproductive endocrinologists, dermatologists, public health experts, researchers, and a project manager with a team to develop the guideline.Evidence:Published literature was retrieved through searches of Medline and The Cochrane Database from January 2003 to December 2017 using appropriate-controlled vocabulary (e.g., oral contraceptive pills, polycystic ovarian syndrome, long term outcomes, infertility). Clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies' publications and data were also reviewed to suggest the recommendations.Process:The working group for guideline committee included members from the PCOS Society (India), Indian Society for Assisted Reproduction, The Mumbai Obstetric and Gynecological Society, The Endocrine Society of India, Indian Association of Dermatologists, Venereologists and Leprologists, Cosmetic Dermatology Society (India), Academicians from Medical Colleges, National Institute for Research in Reproductive Health, and a Research Associate. The core team included five reproductive endocrinologists, five gynecologists, five dermatologists, three endocrinologists, two public health experts and one research associate.Conclusions:This consensus statement provides the guidance/recommendations for Indian practitioners regarding the use of OCP in women with PCOS. PCOS is one of the common endocrinopathies encountered in gynecological/endocrine practice. The spectrum of this disorder may range from prepubertal girls with premature pubarche, young girls with hirsutism, acne and anovulatory cycles, married women with infertility, and elderly women. Although obesity is a common feature for most PCOS patients, 'lean PCOS' also exists. For several years, OCPs have played an important role in the symptom management of PCOS women. This is due to the fact that OCPs decrease the luteinizing hormone, reduce androgen production, and increase sex hormone-binding globulin, which binds androgens. Several new formulations of OCPs have been developed to decrease the side effects. This includes use of less androgenic progestins and lower doses of ethinyl estradiol. These consensus recommendations help the health provider to choose the right type of OCPs, which will alleviate the symptoms with least side effects. It also gives insight into the indications, contraindications, and concerns regarding its short, intermediate and long-term use.

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Dexamethasone and spironolactone in the treatment of non-tumorous hyperandrogenism

Cited by 9 publications

References 17 publications

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review includingGRADEassessments

Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India

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