Endocrine Abstracts

Introduction: Cyproterone acetate is a progestogen that has an androgen receptor antagonist activity.

There is contradictory data regarding its effects on the growth of meningiomas; it has been suggested that progestins promote growth as progesterone receptors predominate in meningioma tissue, but in vitro, it inhibited the growth of meningioma cells. We present a case where a brain meningioma may have grown following anti-androgen therapy for hyper-sexuality.

Case history: Fifty-four years old male sufferer from a sexually driven behavioural disorder was started on cyproterone acetate (legal requirement), alongside anti-psychotics in 1996. Referred to Endocrine clinic in 2001 with gynaecomastia secondary to anti-androgen therapy and mild hyper-prolactinaemia secondary to anti-psychotic medication. Bilateral mastectomy performed in 2003. Admitted with neurological symptoms in 2004 and brain MRI showing lacunar infarcts with small vessel disease and an incidental 1.5 cm left sphenoid wing meningioma. Repeated brain MRI in 2007 showed enlargement of meningioma to 3 cm size and another tumour in the cribiform region. After surgical resection of both meningiomas (WHO grade 1 with extensive areas expressing progesterone receptors), cyproterone acetate was stopped and changed to zoladex injections.

Discussion: The patient’s meningioma almost doubled in size over 2.5 years, and on discussion with the neurosurgical team, this would be most unusual. There was the possibility of cyproterone acetate being implicated in this rapid growth.

Conclusion: Progesterone and synthetic progestins should not be prescribed in patients with menigiomas and an alternative therapy should be offered. It may be good practice to screen patients for meningiomas before commencing cyproterone acetate, and in cases like this, where treatment was legally required (to prevent further sexual offences), may have relevant implications.