Correction of androgen deficiency in a woman with primary adrenal insufficiency. Clinical case

Nurana Nuralieva; Marina Yukina; Ekaterina Troshina; Yulia Absatarova

doi:10.1530/endoabs.73.EP19

Introduction

There is no consensus about the necessity of dehydroepiandrosterone (DHEA) replacement in women with adrenal insufficiency (AI).

Methods

The woman aged 44 with medical compensation of autoimmune 1-AI, 1-hypogonadism, osteoporosis took DHEA (tablets of 50 mg in every morning) during 4 months. Concomitant therapy: hydrocortisone, fludrocortisone, drospirenone+estradiol, colecalciferol, calcium carbonate.

Results


	Units	Baseline	Day		Month
	Units	Baseline	1st	14th	4	7 (3 months after the end of therapy)
DHEA-S	μmol/l	0.003	5.04	5.72	5.74	0.003
SHBG	nmol/l	102.5	–		108.1	102.2
Total testosterone	nmol/l	0.17			0.975	0.17
Free testosterone	pmol/l	1.6			7.7	1.6
Estradiol	pmol/l	415.7			396.57	423.6
Osteocalcin	ng/ml	26.18			21.18	18.29
β-Cross laps		0.64			0.33	0.36
Colecalciferol		24.3			28.3	22.6
AMH		1.10			1.17	1.48
Inhibin B	pg/ml	59			52	60.7
LH	U/l	27.6			14.4	23.9
FSH	U/l	31.5			15.6	32.3
Glucose	mmol/l	4.64			4.04	4.34
Cholesterol	mmol/l	5.68			5.03	5.06
Insulin	μU/ml	4.18			6.51	5.3
HbA1c	%	5.5			5.5	5.8
Hair growth –axillary –pubic (Tanner scale)		No V			Yes V	No V
Ultrasound of the pelvic, mammary glands		n			n
Cytological examination of smears		n
Side effects		–			Slight greasiness of the face
Golombok-Rust Inventory of Sexual Satisfaction-Female
Frequency		5	–		5
Incommunicability		2			3	2
Dissatisfaction		4			3	4
Avoidance		2			0
Anorgasmia		3
Vaginismus		0
Touch					4	0
Hospital Anxiety and Depression Scale
Anxiety		7	–		4	6
Depression		3			2	1
Symptom checklist-90-revised
Somatization		0.75	–		0.5	0.67
Obsessive-Compulsive		0.5			0.8	0.8
Interpersonal Sensitivity		0.11			0.22	0.11
Depression		0.31			0.23	0.31
Anxiety		0.5			0.3	0.4
Hostility		0.33			0.17	0.5
Phobic Anxiety		0			0
Paranoid Ideation
Psychoticism
Positive Symptom Total		28			26	27
Global Severity Index		0.32			0.29	0.34
Positive Symptom Distress Index		1.04			1.00	1.15
SF-36 health status survey
Physical health		43.33	–		51.24	46.42
Physical Functioning		70			80	70
Role-Physical Functioning		0			50
Bodily pain		100			100
General Health		52			70	47
Mental health		45.93			51.93	45.22
Vitality		55			60
Social Functioning		75			75	62.5
Role-Emotional		100			100	66.67
Mental Health		52			76	68
Wechsler Memory Scale
Visual Reproduction		7	–		10	6
Paired Associates		12			15	14
Digits –forward –backward		6 5			6 5	7 4

Conclusion

DHEA-S reached normal values within a day after taking the drug. A positive effect on the quality of life, mood, sexual function, some types of memory, bone metabolism was found. An inverse negative relationship between DHEA-S and gonadotropins is assumed. No significant side effects were observed.

Funding

Russian Science Foundation (project 17-75-30035).

Endocrine Abstracts

EP19