title: In PCOS patients the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism than metformin alone.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is characterized by ovarian dysfunction and hyperandrogenism and by insulin resistance and related metabolic alterations. Both metformin and anti-androgens, such as spironolactone, are used to ameliorate the different aspects of this disorder. We investigated whether therapy with metformin plus low-dose spironolactone is more effective than metformin alone in PCOS patients.
  
  
  RESULTS
  Fifty-six PCOS patients were randomized in two groups: group A (28 patients) was treated with metformin (1700 mg/die) and group B (28 patients) was treated with metformin (1700 mg/die) plus low-dose spironolactone (25 mg/die). Anthropometric, hormonal and metabolic parameters were evaluated at baseline and after six months of treatment. After therapy regular menses were restored in approximately 82% of group A patients (P < 0.001) and in 68% of group B patients (P < 0.001). Circulating testosterone, Δ-4-androstenedione and Hirsutism Score (HS) significantly decreased in both groups. However, dehydro-epiandrosterone sulphate significantly decreased only in group B, and HS underwent a stronger reduction in group B (P < 0.001). At baseline, 39/56 (69.6%) patients met the diagnostic criteria for metabolic syndrome, but only one patient met these criteria after treatment.
  
  
  CONCLUSIONS
  This study confirms the beneficial effects of metformin in PCOS patients. It also indicates that the addition of low-dose spironolactone induces a more marked reduction of clinical and biochemical hyperandrogenism as compared to metformin alone.
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Fruci
authors.affiliation: Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Guzzi
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: B
authors.initials: B
authors.lastname: D'Orrico
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Malaguarnera
authors.affiliation: Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Veltri
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fava
authors.affiliation: Department of Health Sciences, Endocrinology, University Magna Graecia of Catanzaro, Campus Universitario, località Germaneto, 88100 Catanzaro, Italy. Electronic address: belfiore@unicz.it.
authors.forename: A
authors.initials: A
authors.lastname: Belfiore
mesh_terms: D000328:Adult; D000735:Androstenedione / Q000097:blood; D003687:Dehydroepiandrosterone / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006628:Hirsutism / Q000097:blood; D006801:Humans; D017588:Hyperandrogenism / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007333:Insulin Resistance; D008687:Metformin / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D013148:Spironolactone / Q000008:administration & dosage*; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D013148:Spironolactone; D013739:Testosterone; D000735:Androstenedione; D003687:Dehydroepiandrosterone; D008687:Metformin
keywords: Hirsutism; Insulin resistance; Metformin; Obesity; PCOS; Spironolactone