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Endocrine Abstracts (2024) 100 WE2.3 | DOI: 10.1530/endoabs.100.WE2.3

SFEEU2024 Society for Endocrinology Clinical Update 2024 Workshop E: Disorders of the gonads (14 abstracts)

Follicular harmony: triumph over hirsutism with the symphonic intervention of gnrh antagonists

Einas Mohamed & Karim Meeran

Charing Cross Hospital, London, United Kingdom

Gonadotropin-releasing hormone (GnRH) antagonists, primarily used in prostate cancer treatment, have found application in androgen-secreting ovarian tumors. Among these, degarelix, a pure GnRH antagonist was found to rapidly suppress testosterone levels within 24 h. Testosterone fell from 14 nM to 1.5 nM within 24 h and to less than 1 nM within 48 h. A 77-year-old woman presented with hirsutism and voice deepening over the past few months. Elevated serum testosterone levels with non suppressed LH and FSH along with polycythaemia suggested either an ovarian tumour or ovarian hyperthecosis. Pelvic MRI showed a solid enhancing lesion arises from the left adnexa. The gynecology-oncology (MDT) recommendation was laparoscopic bilateral salpingo-oophorectomy (BSO) along with omental and peritoneal biopsies. The patient, expressed reluctance to proceed with surgery. A repeat scan indicated stability in the lesion size with no suspicious features. We therefore initiated a trial of a GNRH antagonist, degarelix 80 mg to determine whether the testosterone was suppressible. The table shows a rapid fall in gonadotropins as well as substantial reduction in testosterone levels.The patient reported significant improvement in hirsutism, noting thicker hair and decreased frequency of headaches. Fatigue has reduced, and overall well-being has improved. The patient tolerated injections well and expressed eagerness to continue. Testosterone levels have consistently remained below 1 nM since initiating the injections. She has been on this treatment for 4 months, with no adverse features, and further scans have shown no growth. The risk of malignancy is not known in these patients, but the response to a fall in gonadotrophins suggests that the production of testosterone is not autonomous. We recommend that patients in this situation have a “degarelix test” and if the testosterone falls within 24 hours, that the patient can continue the drug. Longer term studies of such patients are needed to confirm whether there is a risk of malignancy in these patients, or whether the fact that the lesion is not autonomous excludes malignancy.

Time (hours) LH FSH Testosterone Extracted Testo: SHBG ratio SHBG
Baseline 24.0 45.6 14 43 33
2 15.7 41.1* ---
4 10.2 34.8* 7.5 27.8 27
6 8.7 36.3* 4.5 16.1 28
8 5.6 31.1* 3.2 13.9 23
24 5.4 to 2.8 23.5* to 29.4 1.5 0.8 -
48 (bd) 1.8 to 1.2 15.3* to 21.5 0.8 0.8 and 1.0 -
72 (bd) 1.0 to 1.0 *15.0 14.4 - - 40

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