Tratamento hormonal do hirsutismo baseado em evidências / Evidence-based hormonal treatment of hirsutism

A revisão de estudos baseados em evidências mostra o melhor tratamento hormonal para o hirsutismo. Inicialmente, resumiu-se a fisiologia do pelo, caracterizou-se o hirsutismo, suas variantes e suas causas. Revelou-se que o tratamento hormonal do hirsutismo deve ser complementado pelo tratamento cosmético e não deve ser indicado para mulheres grávidas ou que desejam engravidar. A primeira opção é o contraceptivo hormonal oral, seguro para contracepção e eficaz para tratamento do hirsutismo. Após tempo estipulado, não ocorrendo resposta satisfatória, associar acetato de ciproterona ou espironolactona. A finasterida é indicada para hirsutismo idiopático e a flutamida, devido aos efeitos colaterais, ainda não é opção segura

An evidence-based review shows the best hormonal treatment of hirsutism. This paper summarized the physiology of the hair, characterized the hirsutism, its variants and etiologies. The study revealed that hormonal treatment of hirsutism has to be complemented by esthetic treatment, and it is not recommended for pregnant women or for those who want to get pregnant. The first option is hormonal oral contraceptive, which is safe for contraception and effective for treatment of hirsutism. After a established period of treatment, if good results do not occur, the association of cyproterone or spironolactone is recomended. Finasteride is the treatment of idiopathic hirsutism, and flutamide is not a safe option due to its side effects

Hepatic failure with flutamide.

A 41-year-old woman, who was on flutamide for hair loss for 3 months, presented with deep jaundice. She developed hepatic encephalopathy but gradually recovered after discontinuing flutamide. Flutamide can cause fatal toxic liver injury and hence should be used with close monitoring of liver profile.

Flutamide-induced hepatotoxicity with possible potentiation by simvastatin.

We report a 65 years old male who presented with jaundice in February 2000. He was operated for prostate carcinoma and started on flutamide in May 1999. He developed anorexia in mid January and frank jaundice by end February. LFT showed cholestatic picture. Liver biopsy showed cholestasis. Flutamide was stopped and patient made slow recovery. Possible additional hepatotoxicity of simvastatin is discussed.

effects of orchiectomy, antiandrogen and testosterone on the parotid gland of albino rats

The relationship between the testis and the parotid gland has been poorly investigated. This study deals with the structure of the parotid gland and its changes after orchiectomy, antiandrogen [flutamide] and testosterone substitution. The rat parotid glands of controt and experimental animals [orchimectomized, orchiectomized with testosterone substitution and antiandrogen] were analyzed by light and electron microscopy. Orchiectomy and antiandrogen have more or less similar effects on the parotid gland. Both reduced secretory activity of the gland which was manifested by decreasing the secretory granules, vacuolations of the cytoplasm and degeneration of mitochondria. Exogenously given testosterone can prevent the mentioned effects of orchiectomy on the parotid gland. It is concluded that orchiectomy and antiandrogens affect the rat parotid gland, demonstrating the existence of an interaction between the testis and parotid gland

Flutamida no tratamento da acne / Flutamide in acne treatment

FUNDAMENTOS - A flutamida é potente antiandrógeno näoö-esteróide, deprovido de outras propriedades hormonais ou näo-hormonais, utilizado no tratamento do câncer prostático avançado, e que possui marcada atividade no tratamento do hirsutismo e no bloqueio das glândulas sebáceas. OBJETIVOS - Avaliar a eficácia e segurança da flutamida oral em doses de 250mg/dia na acne näo responsiva aos tratamentos convencionais. MATERIAL E MÉTODOS - Trinta e oito mulheres voluntárias sadias, em idade fértil, com diferentes graus de intensidade de acne e níveis séricos de andrógenos normais foram tratadas com flutamida oral, 125mg/2x/dia por um período de até 18 meses, com acompanhamento clínico e laboratorial bimensal. RESULTADOS - Houve involuçäo total das lesöes clínicas em 34,2 porcento das pacientes, reduçäo de mais da metade da intensidade da acne em 47,4 porcento e reduçäo de menos de um terço das lesões em 7,8 porcento das pacientes. Em 10,6 porcento o quadro manteve-se inalterado ou até pior. Com essa dosagem, näo se observaram efeitos colaterais, clínicos ou laboratoriais, de monta. Após a suspensäo do fármaco, cerca de um terço das pacientes experimentou recidiva do quadro acnéico, com intensidades variáveis. CONCLUSÄO - Muito embora näo podendo ser considerada droga de rotina no tratamento da acne feminina, a flutamida pode constituir-se em alternativa terapêutica bastante útil no combate do hiperandrogenismo cutâneo para algumas pacientes selecionadas

A case of flutamide-induced acute cholestatic hepatitis: a case report

Flutamide, an oral nonsteroidal, antiandrogenic, anilid compound which inhibits the uptake and binding of androgens to nuclear receptors in the prostate, is used with or without LH-RH analogues for treatment of patients with metastatic carcinoma of the prostate. Clinically significant hepatotoxicities such as toxic hepatitis, cholestatic hepatitis, hepatic failure, and even death have rarely been reported in the English literature, but no case has been reported in Korea. A 75-year-old man with metastatic carcinoma of the prostate had taken flutamide (750 mg/day) for 7 months and suddenly developed jaundice and general weakness. The findings of blood chemistries were compatible with cholestatic hepatitis, but ultrasonography, viral marker and auto-antibody studies did not reveal any attributable causes. Histologic examination of a sono-guided liver biopsy only disclosed centrilobular cholestasis, nuclear glycogenosis and mild sinusoidal lymphocytic infiltration. Discontinuation of flutamide resulted in an almost full recovery of the patient's liver function in 2 months. We, herein, report a case of flutamide-induced acute choestatic hepatitis with a brief review of the literature.

Uso de la flutamida en cancer de prostata avanzado: reporte de 40 pacientes / Use of fluotamide in advanced prostatic cancer: report of 40 patients

De marzo a noviembre de 1986, 40 pacientes con carcinoma avanzado de próstata fueron tratados en el Instituto Nacional de Cancerología con Flutamida (750 mg/día, v.o). 22 pacientes (ps) habían recibido DEB, 8 orquiectomizados y 24 habían recibido ambos tratamientos. Solo 16 pacientes eran vírgenes de tratamiento. El promedio de edad fue de 68.7 años (rango 86-57). La distribución histológica fue: 10 G1, 12 G2, 14 G3, 3 G4, 1 G5. Los sitios de metástasis fueron: óseas (38 ps), pulmón, hígado y ganglios linfáticos. Recibieron radioterapia a pelvis en 9 ps. Análisis de los resultados: 40 ps. fueron evaluables, la duración media del tratamiento sin progresión fue de 50 semanas, a 3 mese en el 25% (10/40), respuesta parcial; 35% (15/40) enfermedad estable y 40% (16/40) enfermedad progresiva. Respuesta subjetiva: Desaparición del dolor en 35% (15/40), mejoría del dolor 32.5% (13/40). No se observó ninguna respuesta completa. Los criterios objetivos mostraron: 35% (RP) para el volumen prostático, 60% (RP) para fosfatasa ácida fracción prostática, 12% de las metátasis líticas se recalcificaron, bochornos en el 6%, edema de mamas 3%, mastalgia 3%. No hubo otros datos de toxicidad claramente atribuibles a la droga. En conclusión la Flutamida es un fáramaco seguro y efectivo en el tratamiento del carcinoma avanzado de próstata en pacietnes previamente tratados o, vírgenes de tratamiento