Polycystic Ovary Syndrome Clinical Trial
Official title:
Cortisol Regulation in Polycystic Ovary Syndrome
The purpose of this study is to determine if insulin resistance (how well the body uses insulin and clears sugar) can affect cortisol levels in normal healthy women and women with polycystic ovary syndrome of all body weights.
PCOS is a common clinical problem affecting young women, characterized by oligomenorrhea and
hyperandrogenism. Central obesity and insulin resistance are also prominent features of PCOS,
and in addition are important risk factors for development of hypertension, hyperlipidemia
and atherosclerotic heart disease. Previous studies have suggested that cortisol is
dysregulated in PCOS, primarily through increased hypothalamic-pituitary-adrenal (HPA) axis
activity and enhanced cortisol secretion. Increased adrenocorticotropic hormone (ACTH)
secretion could also potentially lead to elevated adrenal androgen production in PCOS.
Techniques used in previous studies have been inconsistent, however, and a link between
increased HPA axis activity and the phenotypic changes in PCOS has not been clearly
demonstrated. Cortisol is also produced from cortisone in peripheral adipose tissue by the
enzyme 11beta-hydroxysteroid dehydrogenase type 1 (HSD 1), suggesting another potential point
of dysregulation that may contribute to central obesity and insulin resistance in PCOS.
Further investigation of both central and peripheral regulation of cortisol is necessary to
better understand the pathophysiology of PCOS.
Specific Aim 1: To perform a cross-sectional study of women with PCOS and normal controls
matched for age and body mass index, and measure insulin sensitivity and visceral fat, as
well as (a) 24-hour CPR, ACTH, free cortisol, and cortisol binding globulin (CBG), (b)
adipocyte, liver, and whole body HSD 1 activity, and (c) androgen levels.
Specific Aim 2: To prospectively administer pioglitazone or metformin to women with PCOS in a
placebo-controlled trial, and after one month and six months of therapy measure (a) 24-hour
CPR, ACTH, free cortisol, and CBG, (b) adipocyte, liver, and whole body HSD 1 activity, and
(c) insulin sensitivity, visceral fat, and androgen levels.
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