Treatment with flutamide improves hyperinsulinemia in women with idiopathic hirsutism.
OBJECTIVE
To investigate insulin metabolism and its modifications induced by the administration of flutamide, a specific antiandrogen compound, in women with idiopathic hirsutism (IH) and in nonobese women with polycystic ovary syndrome (PCOS).


METHODS
Prospective, randomized trial.


METHODS
Endocrinological Centre of the Department of Obstetrics and Gynecology, University of Caligari, Caligari, Italy.


METHODS
Thirty-two women with normal body mass index participated in the study: 11 with clinical and hormonal features of PCOS and 21 age- and weight-matched normally cycling women with IH (n = 11) and without IH (n = 10, controls).


METHODS
Each subject with PCOS or IH was assigned randomly to receive either flutamide tablets (250 mg twice a day) or placebo for > or =5 months. Twelve subjects (6 with PCOS, 6 with IH) received flutamide and 10 (5 with PCOS, 5 with IH) received placebo. All subjects ingested 75 g of glucose and then underwent an oral glucose tolerance test (OGTT), 3-7 days after spontaneous or medroxyprogesterone acetate (5 mg daily for 5 days)-induced menses. In women with PCOS or IH, the OGTT was repeated at the fourth month of treatment.


METHODS
Fasting and OGTT-stimulated levels of glucose, insulin, and C peptide.


RESULTS
Both fasting and OGTT-stimulated levels of insulin and C peptide were significantly higher in women with PCOS and in those with IH than in controls. Placebo did not modify parameters of glucose metabolism. Flutamide was capable of significantly blunting fasting and OGTT-stimulated secretion of insulin only in women with IH.


CONCLUSIONS
Hyperinsulinemia exists in women with IH as well as in nonobese women with PCOS. Treatment with flutamide can completely reverse hyperinsulinemia only in women with IH, which suggests that the efficacy of the drug is dependent on peripheral androgen hyperactivity.
Paoletti
A M
AM
Istituto di Ginecologia, Ostetricia e Fisiopatologia della Riproduzione Umana, Università degli Studi di Cagliari, Italy.
Cagnacci
A
A
Orrù
M
M
Ajossa
S
S
Guerriero
S
S
Melis
G B
GB
D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D005260:Female; D005485:Flutamide / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood; D005951:Glucose Tolerance Test; D006628:Hirsutism / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006946:Hyperinsulinism / Q000188:drug therapy*; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D000078790:Insulin Secretion; D007986:Luteinizing Hormone / Q000097:blood; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D011446:Prospective Studies
D000726:Androgen Antagonists; D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D005485:Flutamide; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone