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Effects of Dehydroepiandrosterone Therapy on Pubic Hair Growth and Psychological Well-Being in Adolescent Girls and Young Women with Central Adrenal Insufficiency: A Double-Blind, Randomized, Placebo-Controlled Phase III Trial

Pediatric Endocrinology (G.B., S.W., M.E., M.B.R.), University-Children’s Hospital, 72076 Tuebingen, Germany; Center for Coordination of Clinical Studies (N.Z.) and Department of Medical Biometry (C.M.), University of Tuebingen, 72076 Tuebingen, Germany; Pharmacy (L.M.), University of Ulm, 89081 Ulm, Germany; Justus Liebig University, Steroid Research and Mass Spectrometry Unit (S.A.W., M.F.H.), Centre of Child and Adolescent Medicine, 35392 Giessen, Germany; Pediatric Endocrinology (U.H., M.B.), University-Children’s Hospital, 69120 Heidelberg, Germany; Pediatric Endocrinology (H.G.D.), University-Children’s Hospital, D-91054 Erlangen, Germany; and Pediatric Endocrinology (R.W.P., E.K.), University-Children’s Hospital, 04317 Leipzig, Germany

Address all correspondence and requests for reprints to: Professor Dr. Gerhard Binder, Pediatric Endocrinology, University-Children’s Hospital, Hoppe-Seyler-Str.1, 72076 Tuebingen, Germany. E-mail: gerhard.binder{at}med.uni-tuebingen.de.

Context and Objective: The efficacy of oral dehydroepiandrosterone (DHEA) in the treatment of atrichia pubis and psychological distress in young females with central adrenal insufficiency is unknown. Our study aimed to evaluate this therapy.

Design and Patients: A total of 23 young females (mean age 18 yr, range 13–25) was enrolled in a double-blind randomized placebo-controlled trial. Inclusion criteria were ACTH deficiency plus two or more additional pituitary deficiencies, serum DHEA less than 400 ng/ml, and pubertal stage more than B2. Exclusion criteria were cerebral radiation with more than 30 Gy, tumor remission less than 1 yr, amaurosis, hypothalamic obesity, psychiatric disorders, and unstable hormone medication.

Intervention: Patients were randomized to placebo (n = 12) or 25 mg HPLC-purified DHEA/d (n = 11) orally for 12 months after stratification into a nontumor (n = 7) and a tumor group (n = 16).

Main Outcome Measures: Clinical scoring of pubic hair stage was performed at 0, 6, and 12 months (primary endpoint), and psychometrical evaluation (Symptom Check-List-90-R and the Centre for Epidemiological Studies-Depression Scale) at 0 and 12 months (secondary endpoint). Androgen levels and safety parameters were measured at 0, 6, and 12 months; 24-h androgen urinary excretion rates were calculated at 0 and 12 months.

Results: In the placebo group, four patients dropped out because of recurrence of craniopharyngioma, manifestation of type 1 diabetes, and change of residence (n = 2); in the DHEA group, one patient dropped out because of recurrent anxiety attacks. DHEA substitution resulted in normalization of DHEA sulfate and androstanediol glucuronide morning serum levels 2 h after drug intake (P < 0.006), and of its 24 h urinary metabolite levels (P < 0.0001), placebo had no effect. Morning serum levels of androstenedione increased in the DHEA group (P < 0.02) but did not normalize. The DHEA group exhibited significant progress in pubic hair growth from Tanner stage I–III to II–V (mean: +1.5 stages), whereas the placebo group did not (relative risk 0.138; 95% confidence interval 0.021–0.914; P = 0.0046). Importantly, eight of the 10 Symptom Check-List-90-R scores, including those for depression, anxiety, and interpersonal sensitivity, and the global severity index improved in the DHEA group in comparison to the placebo group (P < 0.048). DHEA was well tolerated.

Conclusions: In adolescent girls with central adrenal insufficiency, daily replacement with 25 mg DHEA orally is beneficial: atrichia pubis vanishes, and psychological well-being improves significantly.

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