Garmes Heraldo M, Tambascia Marcos A, Zantut-Wittmann Denise E
Division of Endocrinology, Department of Internal Medicine, School of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
Gynecol Endocrinol. 2005 Dec;21(6):317-23. doi: 10.1080/09513590500430575.
The hyperandrogenism found in polycystic ovary syndrome (PCOS) can be a consequence of hyperinsulinemia as a result of peripheral insulin resistance. Metformin and insulin sensitizers have become a potential therapeutic tool for treating these patients; however, there are few studies with pioglitazone in PCOS. Elevated luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratios and LH hyper-responsivity to stimulation with gonadotropin-releasing hormone (GnRH) are common findings in PCOS. The reason why hyperinsulinemia produces hyperandrogenism and whether insulin action on the pituitary alters gonadotropin liberation remain unknown. In the present study, we evaluated the effect of pioglitazone (30 mg/day for 2 months) on insulin response to an oral glucose tolerance test (OGTT), serum levels of androgens and sex hormone-binding globulin (SHBG), and pituitary gonadotropin response to GnRH stimulation in 15 obese PCOS women. We found a significant decrease in insulin response to the OGTT and also in total and free testosterone levels, an increase in SHBG and a reduction in the LH response to GnRH stimulation after pioglitazone treatment. In conclusion, this short-term treatment with pioglitazone decreased hyperinsulinemia and hyperandrogenemia in obese PCOS patients, and there was a significant reduction in LH response to GnRH stimulation. Further research should be carried out to establish the risks and benefits of pioglitazone, which would assist in the physiopathologic comprehension of PCOS.
多囊卵巢综合征（PCOS）中发现的高雄激素血症可能是外周胰岛素抵抗导致高胰岛素血症的结果。二甲双胍和胰岛素增敏剂已成为治疗这些患者的潜在治疗工具；然而，关于吡格列酮治疗PCOS的研究较少。黄体生成素/促卵泡激素（LH/FSH）比值升高以及LH对促性腺激素释放激素（GnRH）刺激的高反应性是PCOS的常见表现。高胰岛素血症产生高雄激素血症的原因以及胰岛素对垂体的作用是否改变促性腺激素释放尚不清楚。在本研究中，我们评估了吡格列酮（30毫克/天，共2个月）对15名肥胖PCOS女性口服葡萄糖耐量试验（OGTT）的胰岛素反应、雄激素和性激素结合球蛋白（SHBG）血清水平以及垂体促性腺激素对GnRH刺激反应的影响。我们发现，吡格列酮治疗后，OGTT的胰岛素反应以及总睾酮和游离睾酮水平显著降低，SHBG升高，LH对GnRH刺激的反应降低。总之，吡格列酮的这种短期治疗降低了肥胖PCOS患者的高胰岛素血症和高雄激素血症，并且LH对GnRH刺激的反应显著降低。应进一步开展研究以确定吡格列酮的风险和益处，这将有助于对PCOS进行病理生理学理解。
