To the Editor: The Clinical Crossroads by Dr Legro1 discussed options for the treatment of women with polycystic ovary syndrome (PCOS), including issues related to fertility. However, the article did not consider oral administration of low-dose dexamethasone to suppress biosynthesis of adrenal androgens. As monotherapy for the amelioration of hyperandrogenic symptoms, dexamethasone has been found to be effective in inducing ovulation in combination with clomiphene citrate.2 - 3
In addition, we note that the definition of PCOS requires the exclusion of adrenal forms of hyperandrogenemism.4 However, the measurement of basal concentrations of 17-hydroxyprogesterone (17-OHP) may yield false-negative and false-positive results and is less informative than the corticotropin challenge test.5 However, the corticotropin challenge test to exclude congenital adrenal hyperplasia may not be performed in all patients suspected of having PCOS. This test was apparently not offered to Ms R, the patient under discussion. This may lead to misdiagnosing patients with congenital adrenal hyperplasia as having PCOS and provide an additional explanation why dexamethasone is helpful to achieve ovulation in patients presumed to have PCOS.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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