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Effect of Daily and Alternate Day Low Dose Prednisone on Serum Cortisol and Adrenal Androgens in Hirsute Women^*

Division of Endocrinology, Departments of Medicine (R.S.R.) and Pathology (M.L.G.), Dalhousie University Halifax, Nova Scotia, Canada

Address all correspondence and requests for reprints to: Roger S. Rittmaster, M.D., Department of Medicine, Halifax Infirmary, 1335 Queen Street, Halifax, Nova Scotia, Canada B3J 2H6.

To test the hypothesis that alternate day prednisone treatment more effectively suppresses adrenal androgen secretion (compared to cortisol secretion) than daily prednisone treatment, we measured serum dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), and cortisol concentrations during these two prednisone treatment schedules in eight hirsute women. The women were assigned randomly to receive either a daily nighttime dose of prednisone (100 µg/kg) or an alternate nighttime prednisone dose (200 µg/kg) for 4 months. During the following 4 months the women received the other schedule. Serum hormone levels were measured 0, 4, and 8 months before and after iv administration of 25 U synthetic ACTH. To optimally compare the daily and alternate day prednisone regimens, hormonal determinations were made on 2 successive days (days 1 and 2) after the last dose of prednisone. We found no evidence for greater suppression of adrenal androgens or lesser suppression of cortisol with alternate day prednisone treatment. Basal serum DHEA and DHEAS concentrations were suppressed to a greater degree than was cortisol during both daily and alternate day prednisone treatments. ACTH-stimulated DHEA and cortisol concentrations were equally suppressed. Only two of the eight women noted improvement in hirsutism during the study, and four women gained weight. Thus, adrenal androgen secretion was more easily suppressed than was cortisol secretion by this low dose of glucocorticoid, but there was no advantage to alternate day therapy.

^* This work was supported by Grant MA-9619 from the Medical Research Council of Canada and a grant from the Dalhousie University Internal Medicine Research Foundation.

Received March 2, 1988.

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