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Adriaansen BPH, Schröder MAM, Span PN, Sweep FCGJ, van Herwaarden AE, Claahsen-van der Grinten HL. Challenges in treatment of patients with non-classic congenital adrenal hyperplasia. Front Endocrinol (Lausanne) 2022; 13:1064024. [PMID: 36578966 PMCID: PMC9791115 DOI: 10.3389/fendo.2022.1064024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) due to 21α-hydroxylase deficiency (21OHD) or 11β-hydroxylase deficiency (11OHD) are congenital conditions with affected adrenal steroidogenesis. Patients with classic 21OHD and 11OHD have a (nearly) complete enzyme deficiency resulting in impaired cortisol synthesis. Elevated precursor steroids are shunted into the unaffected adrenal androgen synthesis pathway leading to elevated adrenal androgen concentrations in these patients. Classic patients are treated with glucocorticoid substitution to compensate for the low cortisol levels and to decrease elevated adrenal androgens levels via negative feedback on the pituitary gland. On the contrary, non-classic CAH (NCCAH) patients have more residual enzymatic activity and do generally not suffer from clinically relevant glucocorticoid deficiency. However, these patients may develop symptoms due to elevated adrenal androgen levels, which are most often less elevated compared to classic patients. Although glucocorticoid treatment can lower adrenal androgen production, the supraphysiological dosages also may have a negative impact on the cardiovascular system and bone health. Therefore, the benefit of glucocorticoid treatment is questionable. An individualized treatment plan is desirable as patients can present with various symptoms or may be asymptomatic. In this review, we discuss the advantages and disadvantages of different treatment options used in patients with NCCAH due to 21OHD and 11OHD.
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Affiliation(s)
- Bas P. H. Adriaansen
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Mariska A. M. Schröder
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul N. Span
- Radiotherapy & OncoImmunology Laboratory, Radboud Institute of Molecular Life Sciences, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Fred C. G. J. Sweep
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Antonius E. van Herwaarden
- Radboud Institute of Health Sciences, Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hedi L. Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Hedi L. Claahsen-van der Grinten,
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Kapoor R, Shome D, Doshi K, Patel G, Vadera S. Evaluation of efficacy of QR 678 and QR678 neo hair growth factor formulation for the treatment of female pattern alopecia in patients with PCOS-A prospective study. J Cosmet Dermatol 2020; 19:2637-2646. [PMID: 33460214 DOI: 10.1111/jocd.13673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hair is an essential identity of women. Femininity, sexuality, attractiveness, and personality are symbolically linked to a woman's hair. Female pattern hair loss is found in 20%-30% of patients with polycystic ovary syndrome (PCOS). AIM The aim of the present study was to evaluate the efficacy of QR678® and QR678 Neo® therapy in the treatment of female alopecia with PCOS. METHOD A total of 20 females diagnosed with PCOS in the age 25-50 years, with complaints of female pattern alopecia with Ludwig, grades I, and II were selected for the study. At each visit, 1.5 ml solution of QR678® was injected in the scalp skin of patients. A total of eight sessions were performed at an interval of 3 week each. All the patients were evaluated with standard global photography at baseline, 4th and 8th session, and 2 months after 8th session. RESULT Marked improvement was seen in the global photographic assessment score (mean = 8) which was maintained for over 1 year. In videomicroscopic assessment, after four sessions the patients had 8.07 fewer vellus hair, 6.07 more terminal hair, and average hair shaft diameter was 0.82 μm wider. After eight sessions, they had 11.66 fewer vellus hair, 13.77 more terminal hair, and hair shaft diameter was 2.86 μm wider than at baseline. CONCLUSION Intra-dermal injections of QR 678® hair growth factor formulation is an effective option for female pattern alopecia with PCOS. This is the first of its kind study using QR678® and QR678 Neo® in PCOS patients.
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Affiliation(s)
- Rinky Kapoor
- Department of Dermatology, Cosmetic Dermatology & Dermato-Surgery & Director, The Esthetic Clinics, Mumbai, India
| | - Debraj Shome
- Department of Facial Plastic Surgery & Facial Cosmetic Surgery & Director, The Esthetic Clinics, Mumbai, India
| | - Komal Doshi
- Fellow in Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
| | | | - Sapna Vadera
- Fellow Facial Plastic Surgery and Facial Cosmetic Surgery, The Esthetic Clinics, Mumbai, India
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Small B, Millard CEF, Kisanga EP, Burman A, Anam A, Flannery C, Al-Hendy A, Whirledge S. The Selective Progesterone Receptor Modulator Ulipristal Acetate Inhibits the Activity of the Glucocorticoid Receptor. J Clin Endocrinol Metab 2020; 105:5609012. [PMID: 31665442 PMCID: PMC7112983 DOI: 10.1210/clinem/dgz139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT The selective progesterone modulator ulipristal acetate (ulipristal) offers a much-needed therapeutic option for the clinical management of uterine fibroids. Although ulipristal initially passed safety evaluations in Europe, postmarketing analysis identified cases of hepatic injury and failure, leading to restrictions on the long-term use of ulipristal. One of the factors potentially contributing to significant side effects with the selective progesterone modulators is cross-reactivity with other steroid receptors. OBJECTIVE To determine whether ulipristal can alter the activity of the endogenous glucocorticoid receptor (GR) in relevant cell types. DESIGN Immortalized human uterine fibroid cells (UtLM) and hepatocytes (HepG2) were treated with the synthetic glucocorticoid dexamethasone and/or ulipristal. Primary uterine fibroid tissue was isolated from patients undergoing elective gynecological surgery and treated ex vivo with dexamethasone and/or ulipristal. In vivo ulipristal exposure was performed in C57Bl/6 mice to measure the effect on basal gene expression in target tissues throughout the body. RESULTS Dexamethasone induced the expression of established glucocorticoid-target genes period 1 (PER1), FK506 binding protein 51 (FKBP5), and glucocorticoid-induced leucine zipper (GILZ) in UtLM and HepG2 cells, whereas cotreatment with ulipristal blocked the transcriptional response to glucocorticoids in a dose-dependent manner. Ulipristal inhibited glucocorticoid-mediated phosphorylation, nuclear translocation, and DNA interactions of GR. Glucocorticoid stimulation of PER1, FKBP5, and GILZ was abolished by cotreatment with ulipristal in primary uterine fibroid tissue. The expression of glucocorticoid-responsive genes was decreased in the lung, liver, and uterus of mice exposed to 2 mg/kg ulipristal. Interestingly, transcript levels of Fkbp5 and Gilz were increased in the hippocampus and pituitary. CONCLUSIONS These studies demonstrate that ulipristal inhibits endogenous glucocorticoid signaling in human fibroid and liver cells, which is an important consideration for its use as a long-term therapeutic agent.
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Affiliation(s)
- Benjamin Small
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Charles E F Millard
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Edwina P Kisanga
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Andreanna Burman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Anika Anam
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Clare Flannery
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Endocrinology, Yale School of Medicine, New Haven, Connecticut
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois
| | - Shannon Whirledge
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Correspondence and Reprint Requests: Shannon Whirledge, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, Office LSOG 204C, New Haven, CT, 06510. E-mail:
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Adikwu E, Ebinyo NC, Aagbadabina H. Coenzyme Q 10 Abrogates Flutamide-induced Hepatotoxicity in Albino Rats. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2019. [DOI: 10.46347/jmsh.2019.v05i02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Azarchi S, Bienenfeld A, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR. Androgens in women: Hormone-modulating therapies for skin disease. J Am Acad Dermatol 2018; 80:1509-1521. [PMID: 30312645 DOI: 10.1016/j.jaad.2018.08.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/28/2022]
Abstract
Androgen-mediated cutaneous disorders (AMCDs) in women, including acne, hirsutism, and female pattern hair loss, can be treated with hormone-modulating therapies. In the second article in this Continuing Medical Education series, we discuss the hormone-modulating therapies available to dermatologists for the treatment of AMCDs, including combined oral contraceptives, spironolactone, finasteride, dutasteride, and flutamide. Available hormone-modulating treatments used for each AMCDs are reviewed, along with mechanisms of androgen modulation, safety profile, contraindications, monitoring parameters, and evidence of efficacy. Medications discussed include those that are approved by the US Food and Drug Administration for certain AMCDs and some that are used off-label. Despite the ubiquity of hormone-modulating therapies used for AMCDs, this review highlights the need for more rigorous studies to evaluate these therapies for acne, hirsutism, and female pattern hair loss.
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Affiliation(s)
- Sarah Azarchi
- New York University School of Medicine, New York, New York
| | | | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Shari Marchbein
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jerry Shapiro
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Arielle R Nagler
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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Fulghesu AM, Melis F, Murru G, Canu E, Melis GB. Very low dose of flutamide in the treatment of hyperandrogenism. Gynecol Endocrinol 2018; 34:394-398. [PMID: 29108453 DOI: 10.1080/09513590.2017.1397114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Hyperandrogenism is a condition affecting 5-10% of adolescents. The aim of this study was to evaluate the efficacy of very low dose of flutamide in the treatment of hyperandrogenism in adolescence. One hundred and fifty-eight patients, presenting severe acne and/or hirsutism, received 62.5 mg/day of flutamide + ethinylestradiol + gestodene for 18 months. The patients were subjected to assessments of hepatic enzymes levels. Thirty subjects treated with drospirenone + ethinylestradiol represented the control group. After 18 months of treatment, it was obtained a decrease of hirsutism (-39.9%), an almost recovery of acne (98% of patients) with better results of those obtained in control group. Only one case of light hypertransaminasemia was recorded, regressed spontaneously. Very low dose of flutamide was successful and safe and in the treatment of hyperandrogenism in adolescence.
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Affiliation(s)
- Anna Maria Fulghesu
- a Department of Obstetric and Gynecology , Univ di Cagliari , Cagliari , Italy
| | - Federica Melis
- a Department of Obstetric and Gynecology , Univ di Cagliari , Cagliari , Italy
| | - Giulia Murru
- b Department of Obstetrics and Gynecology , Ospedale San Paolo, Università di Milano , Milano , Italy
| | - Elena Canu
- a Department of Obstetric and Gynecology , Univ di Cagliari , Cagliari , Italy
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Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, Pugeat MM, Rosenfield RL. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018. [PMID: 29522147 DOI: 10.1210/jc.2018-00241] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008. PARTICIPANTS The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. CONCLUSION We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin 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 most women who choose hair removal therapy, we suggest laser/photoepilation.
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Affiliation(s)
| | | | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
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Moretti C, Guccione L, Di Giacinto P, Simonelli I, Exacoustos C, Toscano V, Motta C, De Leo V, Petraglia F, Lenzi A. Combined Oral Contraception and Bicalutamide in Polycystic Ovary Syndrome and Severe Hirsutism: A Double-Blind Randomized Controlled Trial. J Clin Endocrinol Metab 2018; 103:824-838. [PMID: 29211888 DOI: 10.1210/jc.2017-01186] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023]
Abstract
CONTEXT Hirsutism often occurs in women with polycystic ovary syndrome (PCOS). The efficacy of oral contraceptive pill (OCP) plus antiandrogens in the treatment of its severe expression is controversial due to the lack of randomized, double-blind, long-term studies. OBJECTIVE The primary outcome was the reduction of hirsutism in PCOS women objectively measured by videodermoscopy on the androgen-sensitive skin areas assessed by the modified Ferriman and Gallwey (mF&G) total score, after 12 months of therapy with OCP + bicalutamide (BC) vs OCP plus placebo (P). The secondary outcomes were to evaluate tolerability of BC and body composition as well as the occurrence of adverse events. DESIGN An experimental, phase 3, prospective, multicenter, randomized, double-blind, P-controlled trial. Patients were evaluated at the baseline visit, at 6 and 12 months during treatment, and 6 months' posttreatment. PARTICIPANTS Seventy women with classic PCOS (severe hirsutism, oligoanovulation, and ovarian polycystic ovarian morphology). INTERVENTION Patients received OCP + BC (50 mg/d) or OCP + P for 12 months. RESULTS The repeated measures analysis of variance showed that both treatments were effective in reducing hirsutism: The OCP + BC group had a higher reduction compared with the OCP + P group. No adverse effects were described during treatment except an increase in total cholesterol and low-density lipoprotein in the OCP + BC group. CONCLUSIONS The association of OCP + BC is well tolerated and significantly more effective than OCP alone in treating severe hirsutism. We suggest a combined use of the videodermoscopic index and mF&G to evaluate the effects of androgen deprivation therapy for hirsutism.
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Affiliation(s)
- Costanzo Moretti
- Department of Systems' Medicine, Unit of Endocrinology, Section of Reproductive Endocrinology, "San Giovanni Calibita" Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Laura Guccione
- Department of Systems' Medicine, Unit of Endocrinology, Section of Reproductive Endocrinology, "San Giovanni Calibita" Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Paola Di Giacinto
- Department of Systems' Medicine, Unit of Endocrinology, Section of Reproductive Endocrinology, "San Giovanni Calibita" Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics & Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Caterina Exacoustos
- Department of Surgery, Unit of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Toscano
- Unit of Endocrinology, Sant'Andrea Hospital, II Faculty of Medicine, University of Rome "Sapienza," Rome, Italy
| | - Cecilia Motta
- Unit of Endocrinology, Sant'Andrea Hospital, II Faculty of Medicine, University of Rome "Sapienza," Rome, Italy
| | - Vincenzo De Leo
- Unit of Obstetrics and Gynecology, "Santa Maria alle Scotte" Hospital, University of Siena, Siena, Italy
| | - Felice Petraglia
- Unit of Obstetrics and Gynecology, "Santa Maria alle Scotte" Hospital, University of Siena, Siena, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Unit of Endocrinology, "Policlinico Umberto I" Hospital, University of Rome "Sapienza," Rome, Italy
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Abstract
PURPOSE OF REVIEW Acne vulgaris is a global disease with increasing prevalence in adolescents. It has a profound impact on their quality of life, especially when endocrine disorders are also involved. Recent concerns regarding antibiotic stewardship, failures with antibiotic usage, and the development of antibiotic-resistant Propionibacterium acnes have led clinicians to consider other therapeutic options for acne treatment. The present review explores hormonal therapies for the treatment of acne vulgaris. RECENT FINDINGS There are now four different combined oral contraceptive pills that are FDA approved for the treatment of acne since its first introduction in 1960. Recent literature has provided more information on the efficacy of different generations of combined oral contraceptive pills, their side-effects, and cancer risks. Furthermore, spironolactone has been gaining wider use among dermatologists in adolescents with endocrine dysfunction. New diagnostic guidelines and treatment recommendations have also been suggested. SUMMARY Hormonal therapies are effective and well tolerated options for the treatment of acne vulgaris in adolescents with and without endocrine disorders. They can be used as monotherapy or in conjunction with benzoyl peroxide, topical retinoic acid, or antibiotics.
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Castelo-Branco C, Hernández-Angeles C, Alvarez-Olivares L, Balasch J. Long-term satisfaction and tolerability with low-dose flutamide: a 20-year surveillance study on 120 hyperandrogenic women. Gynecol Endocrinol 2016; 32:723-727. [PMID: 27176209 DOI: 10.1080/09513590.2016.1184640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the long-term safety, satisfaction and tolerability of flutamide therapy for female hyperandrogenism. DESIGN A 20-year surveillance study. METHODS Setting: Gynecology Department in a teaching hospital. PATIENTS Hyperandrogenic women complaining for hirsutism treatment were followed between February 1995 and April 2015. INTERVENTIONS Women received flutamide 125 or 250 mg/day alone (n = 55) or combined with oral contraceptives (n = 65). MAIN OUTCOME MEASURES Adverse events, safety, tolerability satisfaction and efficacy were assessed every 6 months during all the follow-up. Lab tests including liver and lipid profiles were also recorded in each control. RESULTS Patients under flutamide therapy showed significant improvements in hirsutism scores after 6 months of treatment with a maximum effect at 12 months that was maintained during all the therapy time. Satisfaction reported by patients with the efficacy of the drug in a visual scale was also high. A total of 54.2 % women presented one or more adverse effects during the follow-up; 33.3% showed at least one adverse effect possibly related with the study drug; and 24.1% withdrew from the study because of adverse effects. During the follow-up, as many as 89.9 % of patients abandoned flutamide. Reasons include: questions linked to medical problems (50%), attempt pregnancy (4%) and significant improvement in the symptomatology (35.8%). CONCLUSIONS Flutamide is very effective for hirsutism treatment; however, adverse effects are very frequent and affect compliance.
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Affiliation(s)
- Camil Castelo-Branco
- a Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain and
| | - Claudio Hernández-Angeles
- b Hospital Ginecoobstetricia Número 4 "Luis Castelazo Ayala", Instituto Mexicano del Seguro Social , México DF , Mexico
| | - Lina Alvarez-Olivares
- a Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain and
| | - Juan Balasch
- a Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona , Barcelona , Spain and
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Udhane SS, Dick B, Hu Q, Hartmann RW, Pandey AV. Specificity of anti-prostate cancer CYP17A1 inhibitors on androgen biosynthesis. Biochem Biophys Res Commun 2016; 477:1005-1010. [PMID: 27395338 DOI: 10.1016/j.bbrc.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
The orteronel, abiraterone and galeterone, which were developed to treat castration resistant prostate cancer, inhibit 17,20 lyase activity but little is known about their effects on adrenal androgen biosynthesis. We studied the effect of several inhibitors and found that orteronel was selective towards 17,20 lyase activity than abiraterone and galeterone. Gene expression analysis showed that galeterone altered the expression of HSD3B2 but orteronel did not change the expression of HSD3B2, CYP17A1 and AKR1C3. The CYP19A1 activity was not inhibited except by compound IV which lowered activity by 23%. Surprisingly abiraterone caused complete blockade of CYP21A2 activity. Analysis of steroid metabolome by gas chromatography - mass spectrometry revealed changes in steroid levels caused by different inhibitors. We can conclude that orteronel is a highly specific inhibitor of 17,20 lyase activity. The discovery of these specific drug actions on steroidogenic enzyme activities would be valuable for understanding the regulation of androgens.
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Affiliation(s)
- Sameer S Udhane
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, University Children's Hospital Bern, 3010 Bern, Switzerland; Department of Clinical Research, University of Bern, 3010 Bern, Switzerland
| | - Bernhard Dick
- Department of Clinical Research, University of Bern, 3010 Bern, Switzerland; Department of Nephrology, Hypertension and Clinical Pharmacology, University Hospital of Bern, Bern, Switzerland
| | - Qingzhong Hu
- Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C2.3, Saarbrücken, Germany
| | - Rolf W Hartmann
- Pharmaceutical and Medicinal Chemistry, Saarland University, Campus C2.3, Saarbrücken, Germany; Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E 8.1, 66123 Saarbrücken, Germany
| | - Amit V Pandey
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, University Children's Hospital Bern, 3010 Bern, Switzerland; Department of Clinical Research, University of Bern, 3010 Bern, Switzerland.
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Chen MJ, Ho HN. Hepatic manifestations of women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2016; 37:119-128. [PMID: 27107966 DOI: 10.1016/j.bpobgyn.2016.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/05/2016] [Indexed: 12/11/2022]
Abstract
Women with polycystic ovary syndrome (PCOS) have a higher prevalence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) than the general population. The link between NAFLD/NASH and PCOS is not just a coincidence. Indeed, both of these disorders comprise common risk factors, including central obesity, insulin resistance, chronic low-grade inflammation, and hyperandrogenemia. The characteristics of hyperandrogenemia in women with PCOS include elevated total and free testosterone levels and low sex hormone-binding globulin levels and are reported to be associated with NAFLD and elevated liver enzymes; however, not all elevated androgen levels in women with PCOS have the same adverse effects on the liver. With the exception of weight loss and encouraging exercise in obese women, few evidence-based effective treatments target NAFLD/NASH in women with PCOS. Selective antiandrogens and insulin sensitizers might be beneficial in treating NAFLD/NASH in women with PCOS, but further elucidation is needed.
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Affiliation(s)
- Mei-Jou Chen
- Departments of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Nerng Ho
- Departments of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
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Moghetti P, Carmina E, De Leo V, Lanzone A, Orio F, Pasquali R, Toscano V. How to manage the reproductive issues of PCOS: a 2015 integrated endocrinological and gynecological consensus statement of the Italian Society of Endocrinology. J Endocrinol Invest 2015; 38:1025-37. [PMID: 25835559 DOI: 10.1007/s40618-015-0274-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/17/2015] [Indexed: 01/31/2023]
Affiliation(s)
- P Moghetti
- Endocrinology, Diabetes and Metabolism, University and AOUI of Verona, Verona, Italy,
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Schmidt TH, Shinkai K. Evidence-based approach to cutaneous hyperandrogenism in women. J Am Acad Dermatol 2015; 73:672-90. [PMID: 26138647 DOI: 10.1016/j.jaad.2015.05.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/15/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Hirsutism, acne, and androgenetic alopecia are classically considered signs of cutaneous hyperandrogenism (CHA). These common skin findings have significant impacts on the quality of patients' lives and pose the diagnostic challenge of excluding underlying disorders. Many with CHA have normal serum androgen levels. Hirsutism is more strongly associated with hyperandrogenism than are acne or androgenetic alopecia. Variable association of CHA with hyperandrogenemia results from the complexity of the underlying pathophysiology, including factors local to the pilosebaceous unit. CHA often occurs in the setting of polycystic ovary syndrome, the most common disorder of hyperandrogenism, but can also present in uncommon conditions, including nonclassic adrenal hyperplasia and androgen-producing tumors. A thorough history and full skin examination are important to guide appropriate diagnostic evaluation. Oral contraceptive pills with or without antiandrogens can provide therapeutic benefit for hirsutism and acne. Medical options for androgenetic alopecia remain limited. Multidisciplinary approaches may be needed given endocrine, metabolic, reproductive, and psychiatric disorders associated with CHA. More high-quality studies into the mechanisms of CHA and the benefits of antiandrogenic therapies are needed. We provide an evidence-based review of key diagnostic and therapeutic considerations in the treatment of women with CHA.
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Affiliation(s)
- Timothy H Schmidt
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Kanade Shinkai
- Department of Dermatology, University of California San Francisco, San Francisco, California.
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Gruessner C, Gruessner A, Glaser K, AbuShahin N, Zhou Y, Laughren C, Wright H, Pinkerton S, Yi X, Stoffer J, Azodi M, Zheng W, Chambers SK. Flutamide and biomarkers in women at high risk for ovarian cancer: preclinical and clinical evidence. Cancer Prev Res (Phila) 2014; 7:896-905. [PMID: 24950779 PMCID: PMC4154987 DOI: 10.1158/1940-6207.capr-13-0408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesized that (i) preclinical biologic evidence exists for the role of androgens in ovarian cancer development and (ii) flutamide treatment of women at high risk for ovarian cancer may identify meaningful tissue biomarkers of androgen action and of ovarian cancer initiation. We showed that androgen ablation of male mice led to a 24-fold decrease in tumor burden from serous ovarian cells. In a phase II study, we studied the effect of preoperative flutamide treatment (125 mg/day × 6 weeks) in 12 women versus 47 controls, 47% with BRCA mutation. We analyzed immunohistochemical scores of candidate proteins CSF-1, CSF-1R, and ErbB4 in the epithelium and stroma of fallopian tube, ovary, and ovarian endosalpingiosis. Flutamide decreased the levels, notably, of CSF-1 and ErbB4 in ovarian stroma (P ≤ 0.0006) and ovarian endosalpingiosis (P ≤ 0.01), ErbB4 in ovarian epithelium (P = 0.006), and CSF-1R in ovarian endosalpingiosis (P = 0.009). Our logistic regression model clearly distinguished the flutamide patients from controls (P ≤ 0.0001). Our analysis of the precision of this model of CSF-1 and ErbB4 expression in ovarian stroma achieved 100% sensitivity and 97% specificity (AUC = 0.99). Thus, our data suggest that a short 6-week exposure of flutamide reversed elevated levels of CSF-1 and ErbB4 (both of which we had previously found correlated with high risk status). CSF-1 and ErbB4 in ovarian stroma led to a model with high predictive value for flutamide sensitivity. The effect of flutamide on marker expression in ovarian endosalpingiosis, previously associated with BRCA carrier status, suggests that ovarian endosalpingiosis may be a latent precursor to pelvic serous cancers.
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Affiliation(s)
- Christine Gruessner
- College of Medicine, University of Arizona, Tucson, Arizona. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Angelika Gruessner
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Katherine Glaser
- College of Medicine, University of Arizona, Tucson, Arizona. Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona
| | | | - Yi Zhou
- University of Arizona Cancer Center, Tucson, Arizona
| | | | | | | | - Xiaofang Yi
- University of Arizona Cancer Center, Tucson, Arizona
| | | | - Masoud Azodi
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut
| | - Wenxin Zheng
- College of Medicine, University of Arizona, Tucson, Arizona. University of Arizona Cancer Center, Tucson, Arizona. Department of Pathology, University of Arizona, Tucson, Arizona
| | - Setsuko K Chambers
- College of Medicine, University of Arizona, Tucson, Arizona. Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona. University of Arizona Cancer Center, Tucson, Arizona.
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Abstract
BACKGROUND Hirsutism has a relatively high prevalence among women. Depending upon societal and ethnic norms, it can cause significant psychosocial distress. Importantly, hirsutism may be associated with underlying disorders and co-morbidities. Hirsutism should not simply be looked upon as an issue of cosmesis. Patients require appropriate evaluation so that underlying etiologies and associated sequelae are recognized and managed. Treatment of hirsutism often requires a multidisciplinary approach, and a variety of physical or pharmacologic modalities can be employed. Efficacy of these therapies is varied and depends, among other things, upon patient factors including the underlying etiology, hormonal drive, and local tissue sensitivity to androgens. OBJECTIVE The objective of this paper is to review and summarize current evidence evaluating the efficacy of various treatment modalities for hirsutism in premenopausal women. METHODS Online databases were searched to identify all relevant prior systematic reviews and meta-analyses as well as recently published (2012-present) randomized controlled trials (RCTs) on hirsutism treatment. RESULTS Four recently published RCTs met criteria for inclusion in our review. In addition, one meta-analysis and one systematic review/treatment guideline were identified in the recent literature. Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments. Evidence supports the use of electrolysis for permanent hair removal in localized areas and lasers (particularly alexandrite and diode lasers) for permanent hair reduction. Topical eflornithine can be used as monotherapy for mild hirsutism and as an adjunct therapy with lasers or pharmacotherapy in more severe cases. Combined OCPs as a class are superior to placebo; however, antiandrogenic and low-dose neutral OCPs may be slightly more efficacious in improving hirsutism compared with other types of OCPs. Antiandrogens are indicated for moderate to severe hirsutism, with spironolactone being the first-line antiandrogen and finasteride and cyproterone acetate being second-line antiandrogens. Due to its risk for hepatotoxicity, flutamide is not considered a first-line therapy. If used, the lowest effective dose should be administered with careful monitoring of liver enzymes. Monotherapy with an insulin sensitizer does not significantly improve hirsutism. While insulin sensitizers improve important metabolic and endocrine aberrations in polycystic ovary syndrome, they are not recommended when hirsutism is the sole indication for use. Lifestyle modification counseling is recommended. Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances. Additional therapies without sufficient supportive evidence of efficacy are ovarian surgery, statins (HMG-CoA reductase inhibitors), and vitamin D supplementation. LIMITATIONS In general, most therapies garner recommendations that are weak (where the estimates of benefits versus risks of therapy are either closely balanced or uncertain) and are based on low- to moderate-quality evidence. CONCLUSIONS Risks and benefits of treatment must be carefully considered and discussed with the patient. Expectations for efficacy should be appropriately set. A minimum of 6 months is required to see benefit from pharmacotherapy and lifelong treatment is often necessary for sustained benefit.
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Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab 2013; 11:e9860. [PMID: 24719635 PMCID: PMC3968982 DOI: 10.5812/ijem.9860] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/24/2013] [Accepted: 05/05/2013] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Female pattern hair loss (FPHL) also known as female androgenetic alopecia is a common condition afflicting millions of women that can be cosmetically disrupting. Prompt diagnosis and treatment are essential for obtaining optimal outcome. This review addresses the clinical presentation of female pattern hair loss, its differential diagnosis and treatment modalities. EVIDENCE ACQUISITION A) Diffuse thinning of the crown region with preservation of the frontal hairline (Ludwig's type) B) The "Christmas tree pattern" where the thinning is wider in the frontal scalp giving the alopecic area a triangular shaped figure resembling a christmas tree. C) Thinning associated with bitemporal recession (Hamilton type). Generally, FPHL is not associated with elevated androgens. Less commonly females with FPHL may have other skin or general signs of hyperandrogenism such as hirsutism, acne, irregular menses, infertility, galactorrhea and insulin resistance. The most common endocrinological abnormality associated with FPHL is polycystic ovarian syndrome (PCOS). RESULTS The most important diseases to consider in the differential diagnosis of FPHL include Chronic Telogen Effluvium (CTE), Permanent Alopecia after Chemotherapy (PAC), Alopecia Areata Incognito (AAI) and Frontal Fibrosing Alopecia (FFA). This review describes criteria for distinguishing these conditions from FPHL. CONCLUSIONS The only approved treatment for FPHL, which is 2% topical Minoxidil, should be applied at the dosage of 1ml twice day for a minimum period of 12 months. This review will discuss off-label alternative modalities of treatment including 5-alfa reductase inhibitors, antiandrogens, estrogens, prostaglandin analogs, lasers, light treatments and hair transplantation.
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Affiliation(s)
- Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
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Reply of the Authors. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hepatotoxicity with flutamide. Fertil Steril 2012; 98:e27; author reply e28. [DOI: 10.1016/j.fertnstert.2012.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/23/2012] [Indexed: 11/22/2022]
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