title: Effects of the route of estrogen administration on insulinlike growth factor-I, IGF binding protein-3, and insulin resistance in healthy postmenopausal women: results from a randomized, controlled study.
abstract: OBJECTIVE
  Oral estrogen therapy suppresses insulin like growth factor I (IGF-I) levels, whereas conventional dose transdermal estradiol (E2) does not. However, it has been proposed that if sufficiently high serum E2 levels are achieved, nonoral E2 will also suppress serum IGF-I. The aim of the study was to investigate the effects of intranasal E2 with norethisterone (E2/NET) versus oral E2/NET acetate on IGF-I, IGF binding protein 3, and insulin resistance in postmenopausal women.
  
  
  METHODS
  This was a randomized, multicenter, double-blind, double-dummy trial. Postmenopausal women were randomized to receive either daily intranasal E2/NET (175 microg/275 microg) as a spray and a placebo tablet (n = 41) or oral E2/NET acetate (1 mg/0.5 mg) plus placebo intranasal spray (n = 41) for 1 year. Fasting plasma concentrations of IGF-I, IGF binding protein 3, glucose and insulin, glucose and insulin at 120 minutes post-glucose challenge, and the homeostasis model assessment for insulin resistance were assessed at baseline and after 52 weeks of treatment.
  
  
  RESULTS
  The two groups were well matched for all clinical and biochemical parameters at baseline. There were no significant between-group differences for fasting and 120-minute glucose, insulin, homeostasis model assessment for insulin resistance, and IGF binding protein 3. The mean IGF-I level at week 52 was significantly lower for women treated with oral versus intranasal therapy (116 +/- 21 [SD] versus 134 +/- 33 [SD], P = 0.005) and the mean difference in change over 52 weeks in IGF-I was significantly different between groups (-19, 95% CI:-37 to -1, P = 0.04).
  
  
  CONCLUSIONS
  In healthy postmenopausal women, intranasal E2 at a dose that results in serum levels that exceed the proposed threshold for growth hormone and IGF-I effects, does not alter IGF-I levels. This suggests that the effect of exogenous estrogen on IGF-I is a function of the method of administration rather than being dose related.
authors.affiliation: Women's Health Program, Department of Medicine, Monash Medical School, Alfred Hospital, Prahran, Victoria, Australia. susan.davis@med.monash.edu.au
authors.forename: Susan R
authors.initials: SR
authors.lastname: Davis
authors.forename: Bronwyn G A
authors.initials: BG
authors.lastname: Stuckey
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Norman
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Papalia
authors.forename: Ann
authors.initials: A
authors.lastname: Drillich
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Bell
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D002318:Cardiovascular Diseases; D004305:Dose-Response Relationship, Drug; D004958:Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000187:drug effects*; D007334:Insulin-Like Growth Factor I / Q000187:drug effects*; D008875:Middle Aged; D009640:Norethindrone / Q000008:administration & dosage / Q000009:adverse effects; D017698:Postmenopause / Q000187:drug effects
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D004958:Estradiol; D007334:Insulin-Like Growth Factor I; D009640:Norethindrone