ORAL CONTRACEPTION VERSUS INSULIN SENSITIZATION FOR 18 MONTHS IN NON-OBESE ADOLESCENTS WITH ANDROGEN EXCESS: POST-TREATMENT DIFFERENCES IN C-REACTIVE PROTEIN, INTIMA-MEDIA THICKNESS, VISCERAL ADIPOSITY, INSULIN SENSITIVITY AND MENSTRUAL REGULARITY

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 532-553-Hyperandrogenic Disorders
Basic/Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-547
Lourdes Ibanez*1, Marta Diaz2, Giorgia Sebastiani2, Maria Victoria Marcos3, Abel Lopez-Bermejo4 and Francis Edouard de Zegher5
1Univ of Barcelona, Barcelona, Spain, 2Hospital Sant Joan de Déu, University of Barcelona, Esplugues, Spain, 3Hospital de Terrassa, Terrassa, Spain, 4Dr. Josep Trueta Hospital, and Girona Institute for Biomedical Research,, Spain, 5Univ of Leuven, Leuven, Belgium
Background: An oral estro-progestagen is the standard medication given to adolescent girls with androgen excess, even when those girls are not at risk of pregnancy.

Aim: To compare on- and post-treatment effects of intervention with an oral contraceptive versus an insulin-sensitizing treatment for androgen excess in non-obese adolescents.

Design: Randomized, open-label trial.

Study Population: Non-obese adolescent girls with hyperinsulinemic androgen excess and without risk of pregnancy (mean age 16 yr, BMI 23 kg/m2, N=34).

Interventions: Ethinylestradiol-cyproteroneacetate (EE-CA) versus a low-dose combination of pioglitazone (7.5 mg/d), flutamide (62.5 mg/d) and metformin (850 mg/d) (PioFluMet) for 18 mo; post-treatment follow-up for 6 mo.

Main Outcomes: Androgen excess (hirsutism and acne scores; serum testosterone); glucose-stimulated insulinemia; circulating C-Reactive Protein (CRP); carotid intima media thickness (cIMT); body composition (absorptiometry); abdominal fat partitioning (magnetic resonance imaging); menstrual regularity. 

Results: EE-CA and PioFluMet attenuated androgen excess similarly but had opposing effects – still discernible 6 mo post-treatment – on glucose-induced insulinemia, CRP, cIMT, visceral adiposity, lean mass and menstrual regularity, all these differences pointing to a healthier condition on/after PioFluMet.

Conclusion: The on- and post-treatment effects of PioFluMet compared favourably to those of oral contraception with EE-CA in non-obese adolescents with androgen excess. The intervention whereby androgen excess is reduced in adolescence influences the post-treatment phenotype. PioFluMet-like interventions in adolescence may thus hold the potential to prevent part of the androgen-excess phenotype in adulthood, including adiposity and subfertility.   

Nothing to Disclose: LI, MD, GS, MVM, AL, FED

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: This study was supported by a grant from the Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III, Madrid, Spain (PI09/90444).