Estimation of serum aldosterone, free testosterone and DHEA-S and scalp androgen and aldosterone receptors in female androgenetic alopecia. Is the mystery solved?

Background Genetic variability in the androgen receptor gene is the cardinal prerequisite for the development of early-onset androgenetic alopecia (AGA). Recent studies have reported the prevalence of hypertension among patients with AGA, and proposed that both phenomena may be explained by hyperaldosteronism. Objective To estimate the serum levels of aldosterone, free testosterone and dehydroepiandrosterone sulphate (DHEA-S) and to detect tissue aldosterone receptor and androgen receptor in female patients with AGA, in an attempt to highlight their role in the pathogenesis of AGA. Patients and methods This case control study included 20 female AGA patients and 20 age-matched healthy controls. All cases were subjected to complete history taking, general and dermatological examination. Serum levels of aldosterone and free testosterone by enzyme-linked immunosorbent assay and DHEA-S (solid-phase enzyme immunoassay) were estimated for patients and controls, together with aldosterone and androgen receptors by a real-time PCR from scalp biopsy specimens of involved and noninvolved areas of patients as well as controls. Results There was a significant elevation in serum aldosterone (Po0.001) and free testosterone (Po0.019) in patients when compared with controls; however, the serum level of DHEA-S was higher in cases, with no statistical significance (Po0.176). Both androgen and aldosterone receptor levels were significantly higher in involved areas than in the controls (Po0.001 and Po0.001, respectively), noninvolved areas than the controls (both: Po0.001), and higher in involved than in noninvolved areas (Po0.002 and Po0.001, respectively). Conclusion On the basis of the results, more emphasis is placed on the role of aldosterone, free testosterone and DHEA-S in the pathogenesis of female AGA, with the possible role of androgen and aldosterone receptors. More studies are required to confirm the results and for new lines of therapy.