Pregnancy after treatment with the insulin-sensitizing agent troglitazone in an obese woman with the hyperandrogenic, insulin-resistant acanthosis nigricans syndrome.
OBJECTIVE
To report a case of unassisted pregnancy after 5 months of troglitazone treatment in a severely hyperandrogenic, insulin-resistant woman with acanthosis nigricans (HAIR-AN) previously managed with depot leuprolide acetate (LA) plus oral contraceptive and dexamethasone therapy.


METHODS
Case report.


METHODS
Private infertility clinic.


METHODS
A 28-year-old African-American woman with excessive obesity (body mass index = 42 kg/m2) and HAIR-AN syndrome.


METHODS
Androgen suppression with depot LA plus oral contraceptive and dexamethasone therapy, troglitazone treatment resulting in normalization of fasting insulin and testosterone, spontaneous menses, and an unassisted pregnancy.


METHODS
Luteinizing hormone and testosterone concentrations, fasting insulin and glucose levels, insulin-glucose ratios, hCG levels, and ultrasound examinations.


RESULTS
Spontaneous menses followed by an intrauterine pregnancy after 5 months of treatment with troglitazone, an insulin-sensitizing agent, in a woman with severe HAIR-AN syndrome whose hyperandrogenism previously could be normalized only with depot LA plus oral contraceptive therapy and dexamethasone.


CONCLUSIONS
Troglitazone treatment resulted in attenuation of both hyperinsulinemia and hyperandrogenism in an obese woman with HAIR-AN and resulted in resumption of menses and a spontaneous pregnancy.
Elkind-Hirsch
K E
KE
Center for Reproduction at Gramercy, MacGregor Medical Association, Houston, Texas 77025, USA. kh2196.americanmed.com.
McWilliams
R B
RB
D000052:Acanthosis Nigricans / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002839:Chromans / Q000627:therapeutic use*; D005260:Female; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D011247:Pregnancy; D013844:Thiazoles / Q000627:therapeutic use*; D045162:Thiazolidinediones; D000077288:Troglitazone
D001786:Blood Glucose; D002839:Chromans; D012739:Gonadal Steroid Hormones; D007004:Hypoglycemic Agents; D007328:Insulin; D013844:Thiazoles; D045162:Thiazolidinediones; D000077288:Troglitazone