title: Hormone replacement therapy alters insulin sensitivity in young women with premature ovarian failure.
abstract: In this study, we report the effects of cyclic hormone replacement therapy on carbohydrate metabolism in six women with premature ovarian failure. Using tolbutamide-modified iv glucose tolerance tests patients were evaluated during three different intervals of their second treatment cycle: no hormone replacement, estradiol-only (E2-only) replacement, and E2-plus-medroxyprogesterone acetate (MPA) replacement. Insulin sensitivity and glucose effectiveness were derived using insulin and glucose levels obtained from tolbutamide-modified iv glucose tolerance tests and analyzed with the minimal model computer program. The mean insulin sensitivity (x 10(-4)/min/microU.ml) significantly decreased from 4.0 +/- 0.8 during no hormone replacement and 3.8 +/- 0.8 during E2-only replacement to 2.6 +/- 0.5 (x 10(-4)/min/microU/ml) during E2-plus-MPA replacement (P < 0.005). Glucose effectiveness did not change as a function of the phase of hormone replacement therapy. These findings indicate a significant decrease in sensitivity to insulin associated with MPA treatment but no observable change in insulin sensitivity during the E2-only phase of cyclic steroid replacement therapy in young women. Our results support the hypothesis that impairment of insulin-mediated glucose uptake during the luteal phase of the menstrual cycle is due to increased progesterone secretion.
authors.affiliation: Department of Medicine, Methodist Hospital, Houston, Texas 77030.
authors.forename: K E
authors.initials: KE
authors.lastname: Elkind-Hirsch
authors.forename: L D
authors.initials: LD
authors.lastname: Sherman
authors.forename: R
authors.initials: R
authors.lastname: Malinak
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D004958:Estradiol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood / Q000494:pharmacology*; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016649:Primary Ovarian Insufficiency / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D001786:Blood Glucose; D007328:Insulin; D004958:Estradiol; D017258:Medroxyprogesterone Acetate