446 TREATMENT OF ANDROGEN EXCESS IN ADOLESCENT PATIENTS

Abstract

Fourteen hirsute girls, ages 12-22 yrs (M±SD 17.3±2.7 yrs), in whom 21OH deficiency was excluded by 1 h° IV bolus Cortrosyn test in 1981 were evaluated by a dexamethasone (dex) suppression test (0.5 mg QID) with measurement of serum androgens on d5 and then treated with a bedtime dose of dex (0.5 mg in 10, 0.25 mg in 4) for 7-41 mos (mean 15.7 mos) with visits q3 mos. Baseline free testosterone (FT) was ↑ in 14/14 (19-57 pg/ml); DHAS > 350 ug/dl in 10/14; DHA>790 ng/dl in 8/14; Δ4 > 300 ng/dl in 5/14; urinary 17KS > 15 mg/24 h in 8/14. With the dex test DHAS↓> 50% in all (mean 70%), FT<5 pg/ml in 8/14. With dex treatment DHAS ↓21-92% (mean 51%), FT was < 15 pg/ml in only 4 patients. Hirsutism did not change in 9, ↓ in 4, and ↑ in 1 with dex therapy. Of 9 patients with irregular menses, only 3 became regular on dex. Side effects (striae, weight gain and acne) occurred in 6 on 0.5 mg dex but not on 0.25 mg. The 2 patients with the most striking clinical response to dex did not recur 14 mos and 28 mos off dex. All others off treatment showed ↑ serum androgens. 7/14 (5 with ↑ DS) not responding well to adrenal suppression responded to oral contraceptive therapy with ↓ FT 0.4-6 pg/ml and improved control of hirsutism. The data suggest that single dose dex is satisfactory in patients who maintain FT <15 pg/ml without side effects. In others with adequate suppression by dex test, other schedules or glucocorticoids may be necessary. In hirsute adolescents without adequate suppression of FT, ovarian therapy is required.