acetate-ethinyl estradiol treatment alters urinary 6-sulfatoxymelatonin
excretion in hyperandrogenic women
Luboshitzky 1,2, Paula Herer 2 & Zila Shen-Orr
Endocrine Institute, Haemek Medical Center, Afula, Israel.
2. B.Rappaport Faculty of Medicine, Technion, Israel Institute
of Technology, Haifa, Israel.
3. Endocrine Laboratory, Rambam Medical Center, Haifa, Israel.
melatonin; hyperandrogenism; cyproterone acetate; estradiol;
androgens; adrenal hyperplasia and idiopathic hirsutism
May 24, 2002
Accepted: May 25, 2002
To investigate melatonin production in hyperandrogenic women
before and during treatment with cyproterone acetate and ethinyl
estradiol (Diane 35).
AND METHODS: We studied 10 women with late onset adrenal hyperplasia
due to 21-hydroxylase deficiency (LOCAH) and 10 women with
idiopathic hirsutism (IH). Patients were treated with Diane
35 for four months. Fasting blood samples for the determination
of luteinizing hormone (LH), follicle-stimulating hormone
(FSH), testosterone and dihydroepiandrosterone sulfate (DHEAS)
and 24-hour urine collections for the determination of 6-sulfatoxymelatonin
(aMT6s) excretion were obtained from all patients at baseline
and after 4 months of treatment. Results were compared with
those obtained in 15 control women.
At baseline, women with LOCAH had significantly higher serum
testosterone, 17-hydroxyprogesterone (17OHP) and ACTH stimulated
17OHP values than IH and control women. Their aMT6s values
(51.0±20.5 mg/24h) were significantly higher than the
values in IH (34.3±7.1) and control women (30.5±6.5)
(p< 0.001). Diane 35 treatment significantly decreased
serum LH, FSH and testosterone levels and aMT6s values in
LOCAH patients (29.8±16.6 mg/24h) (p<0.0001) in
These results indicate that hyperandrogenic women with LOCAH
have increased melatonin production. The normalization of
aMT6s and testosterone values during cyproterone acetate-ethinyl
estradiol treatment, suggest that sex steroids either directly
or through the suppression of gonadotropin, modulate melatonin
secretion in these patients.