title: Renal denervation: a potential new treatment modality for polycystic ovary syndrome?
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is associated with sympathetic nervous system activation, insulin resistance, and blood pressure elevation. Renal nerve ablation has been demonstrated to reduce sympathetic outflow and improve blood pressure control. Here we report on the effects of renal denervation on hemodynamic, metabolic, and renal parameters in two obese PCOS patients with hypertension.
  
  
  METHODS
  Sympathetic nerve activity was assessed at baseline using microneurography and norepinephrine spillover measurements. Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp. Measurements of cystatin-C, creatinine clearance, and urinary albumin-creatinine ratio were also obtained. All measurements were repeated 3 months after bilateral renal denervation achieved via percutaneous endovascular radiofrequency ablation.
  
  
  RESULTS
  Muscle sympathetic nerve activity and whole body norepinephrine spillover were substantially elevated at baseline in both patients by approximately 2.5-3-fold. Bilateral renal nerve ablation reduced both indices of sympathetic nerve activity. This was associated with moderate reductions in blood pressure and a substantial improvement in insulin sensitivity by approximately 17.5% in the absence of weight changes at 3-month follow-up. Glomerular hyperfiltration and urinary albumin excretion were also reduced.
  
  
  CONCLUSIONS
  These findings corroborate the relevance of sympathetic activation in PCOS and suggest that renal denervation exerts beneficial effects not only on blood pressure control but also on insulin sensitivity, renal, and endocrine abnormalities characteristic of PCOS.
authors.affiliation: Neurovascular Hypertension and Kidney Disease Laboratory, Baker IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, Melbourne, VIC 8008, Australia. markus.schlaich@bakeridi.edu.au
authors.forename: Markus P
authors.initials: MP
authors.lastname: Schlaich
authors.forename: Nora
authors.initials: N
authors.lastname: Straznicky
authors.forename: Mariee
authors.initials: M
authors.lastname: Grima
authors.forename: Carolina
authors.initials: C
authors.lastname: Ika-Sari
authors.forename: Tye
authors.initials: T
authors.lastname: Dawood
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lambert
authors.forename: Reena
authors.initials: R
authors.lastname: Chopra
authors.forename: Flora
authors.initials: F
authors.lastname: Socratous
authors.forename: Sarah
authors.initials: S
authors.lastname: Hennebry
authors.forename: Nina
authors.initials: N
authors.lastname: Eikelis
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Gavin
authors.initials: G
authors.lastname: Lambert
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D003714:Denervation; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007668:Kidney / Q000294:innervation*; D011085:Polycystic Ovary Syndrome / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D007328:Insulin