Selective effects of pioglitazone on insulin and androgen abnormalities in normo- and hyperinsulinaemic obese patients with polycystic ovary syndrome.
BACKGROUND
To investigate the effectiveness and safety of pioglitazone (45 mg/day) on clinical and endocrine-metabolic features of polycystic ovary syndrome (PCOS), we studied 18 obese PCOS patients, classified as normoinsulinaemic (N-PCOS, n = 6) and hyperinsulinaemic (H-PCOS, n = 12) according to their insulin secretion.


METHODS
Evaluation of clinical signs, hormonal and lipid profile assays, oral glucose tolerance tests and euglycaemic hyperinsulinaemic clamps were performed at baseline and after 2 (visit 2), 4 (visit 3) and 6 (visit 4) months of treatment.


RESULTS
Body weight, body fat distribution and blood pressure remained stable throughout the treatment; hirsutism and acne significantly improved (P < 0.001 for visits 3 and 4 versus baseline) in both groups. A restoration of menstrual cyclicity was observed at visit 4 in 83% (P < 0.001) of H-PCOS and in 33% of N-PCOS. A decrease in LH, LH/FSH ratio, androstenedione and 17-hydroxy-progesterone was observed in both groups, attaining statistical significance in H-PCOS. A significant amelioration of insulin secretion, sensitivity and clearance was obtained in H-PCOS. A trend towards improvement was observed in lipid assessment of both groups. Therapy was well-tolerated.


CONCLUSIONS
Present data suggest that there is a selective effect, partially independent of insulin secretion, of pioglitazone on the clinical and hormonal disturbances of PCOS.
Romualdi
D
D
Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy.
Guido
M
M
Ciampelli
M
M
Giuliani
M
M
Leoni
F
F
Perri
C
C
Lanzone
A
A
D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000152:Acne Vulgaris / Q000150:complications / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D000728:Androgens / Q000097:blood*; D000735:Androstenedione / Q000097:blood; D001824:Body Constitution; D015992:Body Mass Index; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006628:Hirsutism / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D009765:Obesity / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000077205:Pioglitazone; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use*
D000728:Androgens; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D045162:Thiazolidinediones; D000735:Androstenedione; D019326:17-alpha-Hydroxyprogesterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D000077205:Pioglitazone