Endocrine Abstracts

Hirsutism affects 8% of women and forms an important reason for referral to the endocrine services in patients with polycystic ovarian syndrome (PCOS). Although antiandrogens are the mainstay in treatment, one needs to bear in mind that they are not without undesirable side effects.

We present the case of a 37-year old woman, diagnosed with PCOS based on menstrual irregularities and typical ultrasound appearances of her ovaries. Her main concerns were hirsutism affecting face and irregular periods. Clinical examination was normal with weight of 77 kg and blood pressure of 142/70 mm Hg. Initial hormone profile include normal testosterone (3.2 nmol/l, N: 0–3.5), 17-hydroxy progesterone (<2 nmol/l), FSH (6.1 iu/l, N: 2.8–11.3), LH (6.4 iu/l, N: 1.1–11.6). Fasting glucose was 5.3 mmol/l. She tried Dianette and Spironolactone in the past with indifferent results, eventually discontinuing them due to side-effects. Therefore, she was started on metformin along with topical eflornithine cream. Unfortunately, her hirsutism remained worse. After detailed discussion, she preferred to have a contraceptive pill and an antiandrogen. Baseline liver function was normal and therefore was started on cyproterone 50 mg daily. Her symptoms improved significantly and therefore the dose was reduced to 25 mg daily. Unfortunately, she developed type 2 diabetes based on fasting glucose of 7.3 and 7.4 mmol/l, 6 months after treatment with cyproterone. Her fasting glycaemic profile showed a clear tendency to deterioration after cyproterone therapy with levels being 5.3 and 5.7 mmol/l, prior to initiation. She remains insistent on continuing it due to better symptom control.

Cyproterone causes hyperinsulinemia due to decreased hepatic uptake, progressive over time although it apparently improves beta cell function in postmenopausal women with type 2 diabetes. This case illustrates the direct effect of high dose cyproterone on worsening glucose tolerance and tendency to develop type 2 diabetes, even in such high risk population.