Acta Neurochirurgica

, Volume 157, Issue 10, pp 1741–1746 | Cite as

Growth stabilization and regression of meningiomas after discontinuation of cyproterone acetate: a case series of 12 patients

  • Anne Laure Bernat
  • Kenichi Oyama
  • Selma Hamdi
  • Emmanuel Mandonnet
  • Dominique Vexiau
  • Marc Pocard
  • Bernard George
  • Sebastien Froelich
Clinical Article - Brain Tumors



The relationship between meningiomas and exogenous sex hormones is well known, but cyproterone acetate (CA), a progesterone agonist, seems to have a stronger influence on tumor growth.


To show the close relationship between CA treatment and meningioma growth.


Since 2010, all patients referred to our clinic for a suspicion of meningioma were questioned specifically about exogenous sex hormone intake and more specifically about CA intake. Twelve patients harboring one or multiple meningiomas and treated with CA were identified. CA was stopped in all cases. Tumor volumes and diameters were measured on serial MRIs and compared to the last MRI before CA withdrawal.


Ten patients with multiple tumors had been taking the drug for a longer period of time (mean of 20.4 years) than the two patients with one tumor (10 years). Two patients with multiple tumors underwent surgery because of rapidly decreased visual acuity at the time of diagnosis. Discontinuation of CA led to tumor shrinkage in 11 patients and a stop in tumor growth in one [mean tumor volume reduction was around 10 cm3/year; range (0.00; 76)]. There was no regrowth during a mean follow-up period of 12 months (range: 5–35).


For patients diagnosed with a meningioma and treated with CA, medication withdrawal followed by observation should be the first line of treatment. Care should be taken with long-term use of high doses of CA, and serial brain MRIs should be considered after several years of CA.


Cyproterone acetate Meningioma Meningiomatosis Progesterone agonist 


Conflicts of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


  1. 1.
    Adams EF, Schrell UM, Fahlbusch R, Thierauf P (1990) Hormonal dependency of cerebral meningiomas. Part 2: In vitro effect of steroids, bromocriptine, and epidermal growth factor on growth of meningiomas. J Neurosurg 73(5):750–755CrossRefPubMedGoogle Scholar
  2. 2.
    Cebula H, Pham TQ, Boyer P, Froelich S (2010) Regression of meningiomas after discontinuation of cyproterone acetate in a transsexual patient. Acta Neurochir (Wien) 152(11):1955–1956CrossRefGoogle Scholar
  3. 3.
    Clark VE, Erson-Omay EZ, Serin A et al (2013) Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO. Science 339(6123):1077–1080CrossRefPubMedGoogle Scholar
  4. 4.
    Claus EB, Calvocoressi L, Bondy ML, Wrensch M, Wiemels JL, Schildkraut JM (2013) Exogenous hormone use, reproductive factors, and risk of intracranial meningioma in females. J Neurosurg 118(3):649–656PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Fan Z-X, Shen J, Wu Y-Y, Yu H, Zhu Y, Zhan R-Y (2013) Hormone replacement therapy and risk of meningioma in women: a meta-analysis. Cancer Causes Control 24(8):1517–1525CrossRefPubMedGoogle Scholar
  6. 6.
    Gazzeri R, Galarza M, Gazzeri G (2007) Growth of a meningioma in a transsexual patient after estrogen-progestin therapy. N Engl J Med 357(23):2411–2412CrossRefPubMedGoogle Scholar
  7. 7.
    Gil M, Oliva B, Timoner J, Maciá MA, Bryant V, de Abajo FJ (2011) Risk of meningioma among users of high doses of cyproterone acetate as compared with the general population: evidence from a population-based cohort study. Br J Clin Pharmacol 72(6):965–968PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Gonçalves AMG, Page P, Domigo V, Méder J-F, Oppenheim C (2010) Abrupt regression of a meningioma after discontinuation of cyproterone treatment. AJNR Am J Neuroradiol 31(8):1504–1505CrossRefPubMedGoogle Scholar
  9. 9.
    Gruber T, Dare AO, Balos LL, Lele S, Fenstermaker RA (2004) Multiple meningiomas arising during long-term therapy with the progesterone agonist megestrol acetate. Case report. J Neurosurg 100(2):328–331CrossRefPubMedGoogle Scholar
  10. 10.
    Gruber TJ, Fabiano AJ, Deeb G, Lele SB, Fenstermaker RA (2011) Intracranial meningiomas in patients with uterine sarcoma treated with long-term megestrol acetate therapy. World Neurosurg 76(5):477.e16–20CrossRefPubMedGoogle Scholar
  11. 11.
    Grunberg SM, Weiss MH, Spitz IM, Ahmadi J, Sadun A, Russell CA, Lucci L, Stevenson LL (1991) Treatment of unresectable meningiomas with the antiprogesterone agent mifepristone. J Neurosurg 74(6):861–866CrossRefPubMedGoogle Scholar
  12. 12.
    Hsu DW, Efird JT, Hedley-Whyte ET (1997) Progesterone and estrogen receptors in meningiomas: prognostic considerations. J Neurosurg 86(1):113–120CrossRefPubMedGoogle Scholar
  13. 13.
    Klaeboe L, Lonn S, Scheie D, Auvinen A, Christensen HC, Feychting M, Johansen C, Salminen T, Tynes T (2005) Incidence of intracranial meningiomas in Denmark, Finland, Norway and Sweden, 1968–1997. Int J Cancer 117(6):996–1001CrossRefPubMedGoogle Scholar
  14. 14.
    Korhonen K, Raitanen J, Isola J, Haapasalo H, Salminen T, Auvinen A (2010) Exogenous sex hormone use and risk of meningioma: a population-based case–control study in Finland. Cancer Causes Control 21(12):2149–2156CrossRefPubMedGoogle Scholar
  15. 15.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Lusis EA, Scheithauer BW, Yachnis AT, Fischer BR, Chicoine MR, Paulus W, Perry A (2012) Meningiomas in pregnancy: a clinicopathologic study of 17 cases. Neurosurgery 71(5):951–961CrossRefPubMedGoogle Scholar
  17. 17.
    Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, Stroup NE, Kruchko C, Barnholtz-Sloan JS (2013) CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology 15(Suppl 2):ii1–ii56PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Piper JG, Follett KA, Fantin A (1994) Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist contraceptive implant. Neurosurgery 34(4):723–725, discussion 725 CrossRefPubMedGoogle Scholar
  19. 19.
    Pozzati E, Zucchelli M, Schiavina M, Contini P, Foschini MP (2007) Rapid growth and regression of intracranial meningiomas in lymphangioleiomyomatosis: case report. Surg Neurol 68(6):671–674, discussion 674–675 CrossRefPubMedGoogle Scholar
  20. 20.
    Pravdenkova S, Al-Mefty O, Sawyer J, Husain M (2006) Progesterone and estrogen receptors: opposing prognostic indicators in meningiomas. J Neurosurg 105(2):163–173CrossRefPubMedGoogle Scholar
  21. 21.
    Qi Z-Y, Shao C, Huang Y-L, Hui G-Z, Zhou Y-X, Wang Z (2013) Reproductive and exogenous hormone factors in relation to risk of meningioma in women: a meta-analysis. PLoS ONE 8(12):e83261PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Roelvink NC, Kamphorst W, van Alphen HA, Rao BR (1987) Pregnancy-related primary brain and spinal tumors. Arch Neurol 44(2):209–215CrossRefPubMedGoogle Scholar
  23. 23.
    Schrell UM, Koch HU, Marschalek R, Schrauzer T, Anders M, Adams E, Fahlbusch R (1998) Formation of autocrine loops in human cerebral meningioma tissue by leukemia inhibitor factinterleukin-6, and oncostatin M: inhibition of meningioma cell growth in vitro by recombinant oncostatin M. J Neurosurg 88(3):541–548Google Scholar
  24. 24.
    Shimizu J, Matsumoto M, Yamazaki E, Yasue M (2008) Spontaneous regression of an asymptomatic meningioma associated with discontinuation of progesterone agonist administration. Neurol Med Chir (Tokyo) 48(5):227–230CrossRefGoogle Scholar
  25. 25.
    Vadivelu S, Sharer L, Schulder M (2010) Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy. J Neurosurg 112(5):920–924CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Anne Laure Bernat
    • 1
  • Kenichi Oyama
    • 1
  • Selma Hamdi
    • 1
  • Emmanuel Mandonnet
    • 1
    • 3
  • Dominique Vexiau
    • 2
  • Marc Pocard
    • 4
  • Bernard George
    • 1
  • Sebastien Froelich
    • 1
  1. 1.Department of Neurosurgery, Hôpital LariboisièreParis VII-Diderot UniversityParisFrance
  2. 2.Department of GynecologyHôpital LariboisièreParisFrance
  3. 3.Paris VII-Diderot UniversityParisFrance
  4. 4.Department of Visceral SurgeryHôpital LariboisièreParisFrance

Personalised recommendations