Prolonged suppression of hirsutism with combination therapy in an adolescent with insulin resistance and acanthosis nigricans.

Spironolactone and oral contraceptives have been used separately with some success in the treatment of hirsutism. Hirsutism associated with the Kahn type-A syndrome of insulin resistance, acanthosis nigricans, and polycystic ovaries may be severe and refractory to conventional treatment. In view of their different sites and mechanisms of action, spironolactone and an oral contraceptive were used in combination to treat severe hirsutism in a 13-year-old girl with features of this syndrome. The two therapeutic agents, apparently acting together, resulted in a marked reduction in facial hair and serum androgen concentrations, which persisted during 18 months of treatment. Testosterone and androstenedione levels fell from 100 ng/dl and 628 ng/dl, respectively, to 47 ng/dl and 230 ng/dl by six months and to 35 ng/dl and 156 ng/dl by 18 months. This result suggests that combination therapy may be an effective treatment for severe hirsutism.