13-cis-Retinoic acid (isotretinoin) unmasking of clinical polycystic ovary syndrome.
OBJECTIVE
To describe a woman in whom polycystic ovary syndrome manifested during treatment with 13-cis-retinoic acid (isotretinoin) for severe acne.


METHODS
We present serial clinical and biochemical findings for a several month period before, during, and after therapy with 13-cis-retinoic acid. Homeostasis model assessment of insulin resistance was calculated from the fasting plasma glucose and insulin concentrations.


RESULTS
A 32-year-old woman with some past features suggestive of metabolic syndrome took 13-cis-retinoic acid for 20 weeks as treatment of nodulocystic acne. During therapy, amenorrhea and hirsutism developed, as well as biochemical evidence of hyperandrogenemia and insulin resistance, as assessed by homeostasis model assessment of insulin resistance. After discontinuation of the medication, both the clinical features and the laboratory abnormalities resolved.


CONCLUSIONS
13-cis-Retinoic acid likely causes insulin resistance through its role as an agonist of retinoid A and X receptors. Although elevated levels of serum triglycerides are well documented with use of this drug, to the best of our knowledge this is the first report of a patient in whom polycystic ovary syndrome, a condition known to be associated with insulin resistance, manifested during isotretinoin therapy.
Pham
Tan
T
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Scofield
R Hal
RH
D000152:Acne Vulgaris / Q000188:drug therapy; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006628:Hirsutism / Q000139:chemically induced; D006801:Humans; D017588:Hyperandrogenism / Q000139:chemically induced; D007333:Insulin Resistance; D015474:Isotretinoin / Q000009:adverse effects*; D007986:Luteinizing Hormone / Q000097:blood; D011085:Polycystic Ovary Syndrome / Q000175:diagnosis*; D013739:Testosterone / Q000097:blood
D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D015474:Isotretinoin