title: Treatment of androgen excess in adolescent girls: ethinylestradiol-cyproteroneacetate versus low-dose pioglitazone-flutamide-metformin.
abstract: OBJECTIVE
  The aim was to perform a first comparison between the effects of a classic therapy and those of a novel treatment for androgen excess in adolescent girls.
  
  
  METHODS
  We conducted a randomized, open-labeled trial at a university hospital.
  
  
  METHODS
  Thirty-four adolescents with hyperinsulinemic androgen excess and without risk of pregnancy participated in the study.
  
  
  METHODS
  Ethinyl estradiol-cyproterone acetate (EE-CA) vs. a low-dose combination of pioglitazone, flutamide, and metformin (PioFluMet) was administered for 6 months.
  
  
  METHODS
  We assessed hirsutism and acne scores; androgen excess; fasting insulin, lipid profile, C-reactive protein, high molecular-weight adiponectin, leptin, follistatin; carotid intima-media thickness; body composition (absorptiometry); and abdominal fat partitioning (magnetic resonance imaging).
  
  
  RESULTS
  EE-CA and PioFluMet attenuated the androgen excess comparably but had divergent effects on fasting insulinemia; on circulating cholesterol, triglycerides, C-reactive protein, high molecular-weight adiponectin, leptin, and follistatin; on carotid intima-media thickness; on lean mass; and on abdominal, visceral, and hepatic fat, with all these divergences pointing to a healthier condition on low-dose PioFluMet.
  
  
  CONCLUSIONS
  Low-dose PioFluMet compared favorably to EE-CA in adolescents with androgen excess and without pregnancy risk. The efficacy and safety of low-dose PioFluMet remain to be studied over a longer term and in larger cohorts.
authors.affiliation: Endocrinology Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain. libanez@hsjdbcn.org
authors.forename: Lourdes
authors.initials: L
authors.lastname: Ibáñez
authors.forename: Marta
authors.initials: M
authors.lastname: Diaz
authors.forename: Giorgia
authors.initials: G
authors.lastname: Sebastiani
authors.forename: David
authors.initials: D
authors.lastname: Sánchez-Infantes
authors.forename: Cristina
authors.initials: C
authors.lastname: Salvador
authors.forename: Abel
authors.initials: A
authors.lastname: Lopez-Bermejo
authors.forename: Francis
authors.initials: F
authors.lastname: de Zegher
mesh_terms: D050153:Abdominal Fat / Q000187:drug effects / Q000378:metabolism; D000293:Adolescent; D000726:Androgen Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D001823:Body Composition / Q000187:drug effects; D017373:Cyproterone Acetate / Q000494:pharmacology / Q000627:therapeutic use*; D004338:Drug Combinations; D004967:Estrogens / Q000494:pharmacology / Q000627:therapeutic use*; D004997:Ethinyl Estradiol / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005485:Flutamide / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D017588:Hyperandrogenism / Q000188:drug therapy* / Q000378:metabolism; D006946:Hyperinsulinism / Q000188:drug therapy* / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use*; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D004338:Drug Combinations; D004967:Estrogens; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D004997:Ethinyl Estradiol; D017373:Cyproterone Acetate; D005485:Flutamide; D008687:Metformin; D000077205:Pioglitazone