Cyproterone acetate

Cyproterone acetate (CPA), sold alone under the brand name Androcur or with ethinylestradiol under the brand names Diane or Diane-35 among others, is an antiandrogen and progestin medication used in the treatment of androgen-dependent conditions such as acne, excessive hair growth, early puberty, and prostate cancer, as a component of feminizing hormone therapy for transgender women, and in birth control pills.

It is formulated and used both alone and in combination with estrogen, and is available for use by mouth. CPA is taken by mouth one to three times per day.

A study prospectively followed 108 women with 262 intracranial meningiomas and documented progestin cyproterone acetate (PCA) use. A per-meningioma analysis was conducted. Changes in meningioma volumes over time, and meningioma growth velocities, were measured on magnetic resonance imaging (MRI) after stopping PCA treatment.

Mean follow-up time was 30 (standard deviation [SD] 29) mo. Ten (4%) meningiomas were treated surgically at presentation. The other 252 meningiomas were followed after stopping PCA treatment. Overall, followed meningiomas decreased their volumes by 33% on average (SD 28%). A total of 188 (72%) meningiomas decreased, 51 (20%) meningiomas remained stable, and 13 (4%) increased in volume of which 3 (1%) were surgically treated because of radiological progression during follow-up after PCA withdrawal. In total, 239 of 262 (91%) meningiomas regressed or stabilized during follow-up. Subgroup analysis in 7 women with 19 meningiomas with follow-up before and after PCA withdrawal demonstrated that meningioma growth velocity changed statistically significantly (P = .02). Meningiomas grew (average velocity of 0.25 mm3/day) while patients were using PCA and shrank (average velocity of -0.54 mm3/day) after discontinuation of PCA.

Ninety-one percent of intracranial meningiomas in female patients with long-term PCA use decrease or stabilize on MRI after stopping PCA treatment. Meningioma growth kinetics change significantly from growth during PCA usage to shrinkage after PCA withdrawal 1).

a 69-year-old transgender woman who underwent gender-affirming surgery in 1998 and gender-affirming hormone therapy (cyproterone acetate (CPA) and estradiol) since this time. Following an MRI scan to investigate tremor in 2013, an incidental left anterior clinoid and right petrous meningioma were identified. Subtotal surgical resection was achieved for the anterior clinoid meningioma (WHO grade 1, meningothelial subtype). At follow-up in 2016, an olfactory groove meningioma and left greater wing of sphenoid meningioma were identified. By 2017, both tumours, along with the petrous meningioma, demonstrated significant growth. In 2018, clinical decline was evident and MRI demonstrated further tumour growth. Surgery was scheduled and the olfactory groove meningioma was completely resected (WHO grade 2, chordoid subtype). Hormones were stopped, after which regression of the petrous meningioma was observed. This case demonstrates an association between high-dose CPA and estradiol and the development, growth and regression of meningiomas in a transgender woman 2).

Voormolen EHJ, Champagne PO, Roca E, Giammattei L, Passeri T, di Russo P, Sanchez MM, Bernat AL, Yoldjian I, Fontanel S, Weill A, Mandonnet E, Froelich S. Intracranial Meningiomas Decrease in Volume on Magnetic Resonance Imaging After Discontinuing Progestin. Neurosurgery. 2021 Jul 15;89(2):308-314. doi: 10.1093/neuros/nyab175. Erratum in: Neurosurgery. 2021 Jul 23;: PMID: 34166514.
Millward CP, Phillips E, Alalade AF, Gilkes CE. Gender-affirming hormone therapy associated with multiple meningiomas and atypical histology in a transgender woman. BMJ Case Rep. 2021 Jul 14;14(7):e242813. doi: 10.1136/bcr-2021-242813. PMID: 34261631.
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  • Last modified: 2021/07/24 14:20
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