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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 . . . [Full Text of this Article]

Holger S. Willenberg, MD
holger.willenberg@uni-duesseldorf.de

Maryam Bahlo, MD; Matthias Schott, MD, PhD
Department of Endocrinology, Diabetes and Rheumatology
University Hospital Düsseldorf
Düsseldorf, Germany

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