Cyproterone acetate-ethinyl estradiol treatment alters urinary 6-sulfatoxymelatonin excretion in hyperandrogenic women.
OBJECTIVE
To investigate melatonin production in hyperandrogenic women before and during treatment with cyproterone acetate and ethinyl estradiol (Diane 35).


METHODS
We studied 10 women with late onset adrenal hyperplasia due to 21-hydroxylase deficiency (LOCAH) and 10 women with idiopathic hirsutism (IH). Patients were treated with Diane 35 for four months. Fasting blood samples for the determination of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and dihydroepiandrosterone sulfate (DHEAS) and 24-hour urine collections for the determination of 6-sulfatoxymelatonin (aMT6s) excretion were obtained from all patients at baseline and after 4 months of treatment. Results were compared with those obtained in 15 control women.


RESULTS
At baseline, women with LOCAH had significantly higher serum testosterone, 17-hydroxyprogesterone (17OHP) and ACTH stimulated 17OHP values than IH and control women. Their aMT6s values (51.0+/-20.5 mg/24h) were significantly higher than the values in IH (34.3+/-7.1) and control women (30.5+/-6.5) (p< 0.001). Diane 35 treatment significantly decreased serum LH, FSH and testosterone levels and aMT6s values in LOCAH patients (29.8+/-16.6 mg/24h) (p<0.0001) in LOCAH patients.


CONCLUSIONS
These results indicate that hyperandrogenic women with LOCAH have increased melatonin production. The normalization of aMT6s and testosterone values during cyproterone acetate-ethinyl estradiol treatment, suggest that sex steroids either directly or through the suppression of gonadotropin, modulate melatonin secretion in these patients.
Endocrine Institute, Haemek Medical Center, Afula 18101, Israel. luboshitzky_r@clalit.org.il.
Rafael
R
Luboshitzky
Paula
P
Herer
Zila
Z
Shen-Orr
D000293:Adolescent; D000308:Adrenocortical Hyperfunction / Q000188:drug therapy / Q000652:urine; D000328:Adult; D000726:Androgen Antagonists / Q000008:administration & dosage*; D017373:Cyproterone Acetate / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D045166:Estradiol Congeners / Q000008:administration & dosage*; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000188:drug therapy* / Q000652:urine; D008550:Melatonin / Q000031:analogs & derivatives* / Q000378:metabolism / Q000652:urine*
D000726:Androgen Antagonists; D045166:Estradiol Congeners; C054513:6-sulfatoxymelatonin; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; D008550:Melatonin