Metformin administration restores allopregnanolone response to adrenocorticotropic hormone (ACTH) stimulation in overweight hyperinsulinemic patients with PCOS.
OBJECTIVE
To investigate the adrenal response in terms of allopregnanolone secretion in a group of hyperinsulinemic patients with polycystic ovary syndrome (PCOS).


METHODS
Controlled clinical study.


METHODS
Patients with PCOS in a clinical research environment.


METHODS
Twenty-two overweight patients with PCOS with hyperinsulinism were enrolled after informed consent.


METHODS
All patients underwent hormonal evaluations, oral glucose tolerance test (OGTT) and adrenocorticotropic hormone (ACTH) test before and after 4 months of metformin administration (500 mg p.o. bi-daily). Ultrasound examinations and Ferriman-Gallway score were also performed. Main outcome measures. plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), estradiol, 17-hydroxy-progesterone (17OHP), androstenedione (A), testosterone (T), allopregnanolone, glucose, insulin, C peptide concentrations, body mass index (BMI).


RESULTS
Metformin administration reduced significantly LH, A, T, insulin and BMI, while allopregnanolone was significantly increased with no change in progesterone plasma levels. Insulin response to OGTT decreased and allopregnanolone response to ACTH stimulation before while this was restored after the treatment interval. The Ferriman-Gallway score as well as the ovarian volume was significantly decreased after 4 months of metformin therapy.


CONCLUSIONS
In overweight patients with PCOS with hyperinsulinism, allopregnanolone secretion is impaired and metformin administration restored normal allopregnanolone concentrations modulating both steroid syntheses from the ovaries and from adrenal gland.
Genazzani
Alessandro D
AD
Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia, Italy. algen@unimo.it
Chierchia
Elisa
E
Rattighieri
Erika
E
Santagni
Susanna
S
Casarosa
Elena
E
Luisi
Michele
M
Genazzani
Andrea R
AR
D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage*; D000328:Adult; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000097:blood; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008687:Metformin / Q000008:administration & dosage*; D050177:Overweight / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D011280:Pregnanolone / Q000097:blood / Q000378:metabolism*; D055815:Young Adult
D007004:Hypoglycemic Agents; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D008687:Metformin; D011280:Pregnanolone