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Terapia farmacologica di irsutismo e androgenizzazione

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L’Endocrinologo Aims and scope

Riassunto

L’androgenizzazione cutanea femminile, nelle sue varie espressioni cliniche, è determinata da una iperstimolazione dell’apparato pilo-sebaceo da parte degli androgeni. Può essere idiopatica o sintomatica ed è efficacemente trattata con farmaci ad attività antiandrogena. In questo articolo vengono illustrate le molecole dotate di attività antiandrogena, il loro meccanismo d’azione, gli schemi terapeutici più maneggevoli ed efficaci utilizzabili nella pratica clinica e gli eventuali effetti collaterali. Si accenna, altresì, ai trattamenti medico-estetici utilizzabili in tali forme.

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Bibliografia

  1. Azziz R. The evaluation and management of hirsutism. Obstet Gynecol 101 (5 part 1): 995, 2003.

    Article  PubMed  Google Scholar 

  2. Breitkopf DM, Rosen MP, Young SL, Nagamani M. Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism. Contraception 67: 349, 2003.

    Article  PubMed  CAS  Google Scholar 

  3. Van Vloten WA, van Haselen CW, van Zuuren EJ, Gerlinger C, Heithecker R. The effect of 2 combined oral contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Cutis 69: 2, 2002.

    PubMed  Google Scholar 

  4. Cassidenti DL, Paulson RJ, Serafini P, Stanczyk FZ, Lobo RA. Effects of sex steroids on skin 5 alpha-reductase activity in vitro. Obstet Gynecol 78: 103, 1991.

    PubMed  CAS  Google Scholar 

  5. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs 63: 463, 2003.

    Article  PubMed  CAS  Google Scholar 

  6. Kelestimur F. Diane 35 and spironolactone combination in the treatment of hirsutism. Clin Endocrinol (Oxf) 54: 699, 2001.

    Article  CAS  Google Scholar 

  7. Sert M, Tetiker T, Kirim S. Comparison of the efficiency of antiandrogenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism. Acta Med Okayama 57: 73, 2003.

    PubMed  CAS  Google Scholar 

  8. Seaman HE, de Vries CS, Farmer RD. Differences in the use of combined oral contraceptives among women with and without acne. Hum Reprod 18: 515, 2003.

    Article  PubMed  CAS  Google Scholar 

  9. Kelestimur F, Sahin Y. Comparison of Diane 35 and Diane 35 plus spironolactone in the treatment of hirsutism. Fertil Steril 69: 66, 1998.

    Article  PubMed  CAS  Google Scholar 

  10. Thorneycroft IH. Yasmin: the reason why. Eur J Contracept Reprod Health Care 7(Suppl 3): 13, 2002.

    PubMed  CAS  Google Scholar 

  11. Elger W, Beier S, Pollow K, Garfield R, Shi SQ, Hillisch A. Conception and pharmacodynamic profile of drospirenone. Steroids 68: 891, 2003.

    Article  PubMed  CAS  Google Scholar 

  12. Lemay A, Poulin Y. Oral contraceptives as antiandrogenic treatment of acne. J Obstet Gynaecol Can 24: 559, 2002.

    PubMed  Google Scholar 

  13. Spitzer WO, Lewis MA, Heinemann LAJ, Thorogood M, MacRae K.D. Third generation oral contraceptives and risk of venous thromboembolic disorders: an international case-control study. Br Med J 312: 83, 1996.

    Article  CAS  Google Scholar 

  14. Van Grootheest K, Vrieling T. Thromboembolism associated with the new contraceptive Yasmin. Br Med J 326: 257, 2003.

    Article  Google Scholar 

  15. Fruzzetti F, Ricci C, Fioretti P. Haemostasis profile in smoking and non-smoking women taking low-dose oral contraceptives. Contraception 49: 579, 1994.

    Article  PubMed  CAS  Google Scholar 

  16. Escobar-Morreale HF, Lasuncion MA, Sancho J. Treatment of hirsutism with ethinyl estradiol-desogestrel contraceptive pills has beneficial effects on the lipid profile and improves insulin sensitivity. Fertil Steril 74: 816, 2000.

    Article  PubMed  CAS  Google Scholar 

  17. Conn JJ, Jacobs HS. Managing hirsutism in gynaecological practice. Br J Obstet Gynaecol 105: 687, 1998.

    Article  PubMed  CAS  Google Scholar 

  18. Pascale M-M, Pugeat M, Roberts M, Rousset H, Déchaud H, Dutrieux-Berger N, Tourniaire J. Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing tumours. Clin Endocrinol (Oxf) 41: 571, 1994.

    Article  CAS  Google Scholar 

  19. Di Bisceglie C, Brocato L, Tagliabue M, Bertagna A, Gianotti L, Ghigo E, Manieri C. Acute goserelin administration inhibits gonadotropin and androgen secretion in post-menopausal women with ovarian hyperandrogenism. J Endocrinol Invest 26: 206, 2003.

    Article  PubMed  Google Scholar 

  20. Efstathiadou Z, Tsatsoulis A. Long-term remission of ovarian hyperandrogenism after short-term treatment with a gonadotropin-releasing hormone agonist. Fertil Steril 75: 59, 2001.

    Article  PubMed  CAS  Google Scholar 

  21. Andreyko JL, Monroe SE, Jaffe RB. Treatment of hirsutism with a gonadotropin-releasing hormone agonist (Nafarelin). J Clin Endocrinol Metab 63: 854, 1986.

    Article  PubMed  CAS  Google Scholar 

  22. Rittmaster RS. Gonadotropin-Releasing Hormone (GnRH) Agonists and estrogen/progestin replacement for the treatment of hirsutism: evaluating the results. J Clin Endorinol Metab 80: 3403, 1995.

    CAS  Google Scholar 

  23. Carmina E, Lobo RA. Gonadotrophinreleasing hormone agonist therapy for hirsutism is as effective as high dose cyproterone acetate but results in a longer remission. Hum Reprod 12: 663, 1997.

    Article  PubMed  CAS  Google Scholar 

  24. Vidal-Puig AJ, Munoz-Torres M, Jodar-Gimeno E, Garcia-Calvente CJ, Lardelli P, Ruiz-Requena ME, Escobar-Jimenez F. Ketoconazole therapy: hormonal and clinical effects in non-tumoral hyperandrogenism. Eur J Endocrinol 130: 333, 1994.

    Article  PubMed  CAS  Google Scholar 

  25. Hammerstein J, Cupceancu B. Behandlung des Hirsutismus mit Cyproteronacetat. Dtsch Med Wochenschr 94: 829, 1969.

    Article  PubMed  CAS  Google Scholar 

  26. Molinatti GM, Messina M, Manieri C, Massucchetti C, Biffignandi P. Current approaches to the treatment of virilizing syndromes. In: Molinatti GM, Martini L, James VHT (Eds) Androgenization in women. Raven Press, New York, 1983, p 179.

    Google Scholar 

  27. Fruzzetti F, Bersi C, Parrini D, Ricci C, Genazzani AR. Treatment of hirsutism: comparison between different antiandrogens with central and peripheral effects. Fertil Steril 71: 445, 1999.

    Article  PubMed  CAS  Google Scholar 

  28. Oral contraceptives and liver cancer. Results of the Multicentre International Liver Tumor Study (MILTS). Contraception 56: 275, 1997.

    Article  Google Scholar 

  29. Carmina E. Anti-androgens for the treatment of hirsutism. Exp Opin Invest Drugs 11: 357, 2002.

    Article  CAS  Google Scholar 

  30. Carmina E, Lobo RA. A comparison of the relative efficacy of antiandrogens for the treatment of acne in hyperandrogenic women. Clin Endocrinol (Oxf) 57: 231, 2002.

    Article  CAS  Google Scholar 

  31. Menard RH, Stripp B, Gillette JR. Spironolactone and testicular cytochrome P-450: decreased testosterone formation in several species and changes in hepatic drug metabolism. Endocrinology 94: 1628, 1974.

    Article  PubMed  CAS  Google Scholar 

  32. Serafini P, Lobo RA. The effects of spironolactone on adrenal steroidogenesis in hirsute women. Fertil Steril 44: 595, 1985.

    PubMed  CAS  Google Scholar 

  33. Shapiro G, Evron S. A novel use of spironolactone: treatment of hirsutism. J Clin Endocrinol Metab 51: 429, 1978.

    Article  Google Scholar 

  34. Spritzer PM, Lisboa KO, Mattiello S, Lhullier F. Spironolactone as a single agent for long-term therapy of hirsute patients. Clin Endocrinol (Oxf) 52: 587, 2000.

    Article  CAS  Google Scholar 

  35. Lumachi F, Rondinone R. Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism. Fertil Steril 79: 942, 2003.

    Article  PubMed  Google Scholar 

  36. Messina M, Manieri C, Musso MC, Pastorino R. Oral and topical spironolactone therapies in skin androgenization. Panminerva Med 32: 1, 1990.

    Google Scholar 

  37. Shaw JC, White LE. Long-term safety of spironolactone in acne: results of an 8-year follow-up study. J Cutan Med Surg 6: 541, 2002.

    Article  PubMed  Google Scholar 

  38. Taner C, Inal M, Basogul O, Onoglu A, Karanfil C, Tinar S, Ispahi O. Comparison of the clinical efficacy and safety of flutamide versus flutamide plus an oral contraceptive in the treatment of hirsutism. Gynecol Obstet Invest 54: 105, 2002.

    Article  PubMed  CAS  Google Scholar 

  39. Moghetti P, Tosi F, Tosti A, Negri C, Misciali C, Perrone F, Caputo M, Muggeo M, Castello R. Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. J Clin Endocrinol Metab 85: 89, 2000.

    PubMed  CAS  Google Scholar 

  40. Ibáñez L, Potau N, Marcos MV, de Zegher F. Treatment of hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia and hyperinsulinism in nonobese, adolescent girls: effect of flutamide. J Clin Endocrinol Metab 85: 3251, 2000.

    PubMed  Google Scholar 

  41. Carmina E, Lobo RA. Treatment of hyperandrogenic alopecia in women. Fertil Steril 79: 91, 2003.

    Article  PubMed  Google Scholar 

  42. Muderris II, Bayram F. Clinical efficacy of lower dose flutamide 125 mg/day in the treatment of hirsutism. J Endocrinol Invest 22: 165, 1999.

    Article  PubMed  CAS  Google Scholar 

  43. Cilotti A, Danza G, Serio M. Clinical application of 5α-reductase inhibitors. J Endocrinol Invest 24: 199, 2001.

    Article  PubMed  CAS  Google Scholar 

  44. Fruzzetti F, de Lorenzo D, Parrini D, Ricci C. Effects of finasteride, a 5 alpha-reductase inhibitor, on circulating androgens and gonadotropin secretion in hirsute women. J Clin Endocrinol Metab 79: 831, 1994.

    PubMed  CAS  Google Scholar 

  45. Manieri C, Grosso T, Di Bisceglie C, Fornengo R, Tagliabue M, Martina V, Taliano M, Bertagna A. Finasteride in idiopathic hirsutism: its effectiveness in blocking 5α-reductase. Int J Immunopathol Pharmacol 10: 139, 1997.

    CAS  Google Scholar 

  46. Bayram F, Muderris II, Guven M, Kelestimur F. Comparison of high-dose finasteride (5 mg/day) versus low-dose (2.5 mg/day) in the treatment of hirsutism. Eur J Endocrinol 147: 467, 2002.

    Article  PubMed  CAS  Google Scholar 

  47. Sahin Y, Dilber S, Kelestimur F. Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism. Fertil Steril 75: 496, 2001.

    Article  PubMed  CAS  Google Scholar 

  48. Muderris II, Bayram F, Ozcelic B, Guven M. New alternative treatment in hirsutism: bicalutamide 25 mg/day. Gynecol Endocrinol 16: 63, 2002.

    Article  PubMed  CAS  Google Scholar 

  49. Charmandari E, Calis KA, Keil MF, Mohassel MR, Remaley A, Merke DP. Flutamide decreases cortisol clearance in patients with congenital adrenal hyperplasia. J Clin Endocrinol Metab 87: 3197, 2002.

    Article  PubMed  CAS  Google Scholar 

  50. Carmina E, Lobo RA. The addition of dexamethasone to antiandrogen therapy for hirsutism prolongs the duration of remission. Fertil Steril 69: 1075, 1998.

    Article  PubMed  CAS  Google Scholar 

  51. Lor P, Lennartz B, Ruedlinger R. Patient satisfaction study of unwanted facial and body hair: 5 years experience with intense pulsed light. J Cosmet Leasr Ther 4: 73, 2002.

    Article  CAS  Google Scholar 

  52. Loo WJ, Lanigan SW. Laser treatment improves quality of life of hirsute females. Clin Exp Dermatol 27: 439, 2002.

    Article  PubMed  CAS  Google Scholar 

  53. Moreno-Arias GA, Castelo-Branco C, Ferrando J. Side effects after IPL photodepilation. Dermatol Surg 28: 1131, 2002.

    Article  PubMed  Google Scholar 

  54. Sanchez LA, Perez M, Azziz R. Laser hair reduction in the hirsute patient: a critical assessment. Hum Reprod Update 8: 169, 2002.

    Article  PubMed  Google Scholar 

  55. Messina M, Manieri C, Rizzi G, Gentile L, Milani P. Treating acne with antiandrogens: the confirmation of the validity of a percutaneous treatment with spironolactone. Curr Ther Res Clin Exp 38: 269, 1985.

    Google Scholar 

  56. Ferriman D, Gallwey JD. Clinical assesment of body hair growth in women. J Clin Endocrinol Metab 21: 1440, 1961.

    Article  PubMed  CAS  Google Scholar 

  57. Negri C, Tosi F, Dorizzi R, Fortunato A, Spiazzi GG, Muggeo M, Castello R, Moghetti P. Antiandrogen drugs lower serum prostate-specific antigen (PSA) levels in hirsute subjects: evidence that serum PSA is a marker of androgen action in women. J Clin Endocrinol Metab 85: 81, 2000.

    PubMed  CAS  Google Scholar 

  58. Kokaly W, McKenna TJ. Relapse of hirsutism following long-term successful treatment with oestrogen-progestogen combination. Clin Endocrinol (Oxf) 52: 379, 2000.

    Article  CAS  Google Scholar 

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Correspondence to Chiara Manieri.

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Manieri, C., Di Bisceglie, C. & Brocato, L. Terapia farmacologica di irsutismo e androgenizzazione. L’Endocrinologo 4, 118–130 (2003). https://doi.org/10.1007/BF03344463

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