Abstract
A 23-year-old female with polycystic ovary syndrome (PCOS) and a growth-hormone (GH)-producing pituitary adenoma is described. A reduction in the elevated GH levels to normal levels following the administration of dopaminergic agents decreased plasma insulin-like growth factor (IGF)-1 and ovarian dysfunction. Menstrual cycles were therefore restored and the number of ovarian cysts reduced, suggesting that insulin and/or IGF-1, stimulators of theca cell proliferation, may be pathogenetic factors in PCOS.
References
1.
Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T: Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992;41:1257–1266.
2.
Dunaif A: Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis. Rev 1997;18:774–800.
3.
Franks S: Polycystic ovary syndrome. N Engl J Med 1995;333:853–861.
4.
Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF: A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000;85:2434–2438.
5.
Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI: A survey of the polycystic ovary syndrome in the Greek island of Lesbos: Hormonal and metabolic profile. J Clin Endocrinol Metab 1999;84:4006–4011.
6.
Dunaif A, Scott D, Finegood D, Quintana B, Whitcomb R: The insulin-sensitizing agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovary syndrome. J Clin Endocrinol Metab 1996;81:3299–3306.
7.
Ehrmann DA, Schneider DJ, Sobel BE, Cavaghan MK, Imperial J, Rosenfield RL, Polonsky KS: Troglitazone improves defects in insulin action, insulin secretion ovarian steroidogenesis, and fibrinolysis in women with polycystic ovarian syndrome. J Clin Endocrinol Metab 1997;82:2108–2116.
8.
Nestler JE, Jakubowicz DJ: Decreases in ovarian cytochrome P450c17α activity and serum free testosterone after reduction of insulin secretion in polycystic ovary syndrome. N Engl J Med 1996;335:617–623.
9.
Nahum R, Thong KJ, Hillier SG: Metabolic regulation of androgen production by human thecal cells in vitro. Hum Reprod 1995;10:75–81.
10.
Mason HD, Cwyfan-Hughes SC, Heinrich G, Franks S, Holly JMP: Insulin-like growth factor (IGF-1) and IGF-2, IGF-binding proteins, and IGF-binding protein proteases are produced by theca and stroma of normal and polycystic human ovaries. J Clin Endocrinol Metab 1996;81:276–284.
11.
Duleba AJ, Spaczynski RZ, Olive DL, Behrman HR: Effects of insulin and insulin-like growth factors on proliferation of rat ovarian theca-interstitial cells. Reprod 1997;56:891–897.
12.
Adams J, Polson DW, Franks S: Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med 1986;293:355–359.
13.
Ardaens Y, Robert Y, Lemaitre L, Fossati P, Dewailly D: Polycystic ovarian disease: Contribution of vaginal endosonography and reassessment of ultrasonic diagnosis. Fertil Steril 1991;55:1062–1068.
14.
Fulghesu AM, Lanzone A, Cucinelli F, Caruso A, Mancuso S: Long-term naloxone treatment reduces the exaggerated insulin secretion in patients with polycystic ovary disease. Obstet Gynecol 1993;82:191–197.
15.
Robinson S, Chan SP, Spacy S, Anyaoku V, Johnston DG, Franks S: Postprandial thermogenesis is reduced in polycystic ovary syndrome and is associated with increased insulin resistance. Clin Endocrinol (Oxf) 1992;36:537–543.
16.
Dunaif A, Futterweit W, Segal KR, Dobrjansky A: Profound peripheral insulin resistance, independent from obesity, in the polycystic ovary syndrome. Diabetes 1989;38:1165–1174.
17.
Dunaif A, Graf M, Mandeli J, Laumas V, Dbrjansky A: Characterization of groups of hyperandrogenic women with acanthosis nigricans, impaired glucose tolerance, and/or hyperinsulinemia. J Clin Endocrinol Metab 1987;65:499–507.
18.
Chang RJ, Nakamura RM, Judd HL, Kaplan SA: Insulin resistance in nonobese patients with polycystic ovarian disease. Clin Endocrinol Metab 1983;57:356–362.
19.
Lanzone A, Fulgesu AM, Andreani CL: Insulin secretion in polycystic ovarian disease: Effect of ovarian suppression by GnRH agonist. Hum Reprod 1990;5:143–149.
20.
Thierry van Dessel HJ, Lee PD, Faessen G, Fauser BC, Giudice LC: Elevated serum levels of free insulin-like growth factor I in polycystic ovary syndrome. J Clin Endocrinol Metab 1999;84:3030–3035.
21.
Leroith D, Werner H, Beitner-Johnson D, Roberts CT Jr: Molecular and cellular aspects of the insulin-like growth factor I receptor. Endocr Rev 1995;16:143–163.
22.
Matsumoto K, Miyake S, Yano M, Ueki Y, Yamaguchi Y, Akazawa S, Tominaga Y: Glucose tolerance, insulin secretion, and insulin sensitivity in nonobese and obese Japanese subjects. Diabetes Care 1997;20:1562–1568.
23.
Plymate SR, Matej LA, Jones RE: Inhibition of sex hormone binding globulin production in the human hepatoma (Hep G2) cell line by insulin and prolactin. J Clin Endocrinol Metab 1988;67:460–464.
24.
Bratusch-Marrian PR, Smith D, Defronzo RA: The effects of growth hormone on glucose metabolism and insulin secretion in men. J Clin Endocrinol Metab 1982;55:972–983.
25.
Rizza RA, Mandarino LJ, Gerich JE: Effects of growth hormone on insulin action in men: Mechanism of insulin resistance, impaired suppression of glucose production, and impaired stimulation of glucose utilization. Diabetes 1982;31:663–669.
26.
Finberg SE, Merimee TJ: Acute metabolic effects of human growth hormone. Diabetes 1978;23:499–504.
27.
Moller N, Jorgensen JO, Moller J, Orskow L, Ovesen P, Schmits O, Christensen JS, Orskov H: Metabolic effects of growth hormone in humans. Metabolism 1995;44(suppl 4):33–36.
28.
Apa R, Caruso A, Andreani CL, Miceli F, Lazzarin N, Mastrandrea M, Ronsisvalle E, Mancuso S, Lanzone A: Growth hormone stimulates androsterone synthesis by rat theca-interstitial cells. Mol Cell Endocrinol 1996;118:95–101.
29.
Seibel MM, Oskowitz S, Kamrava M, Taymor ML: Bromocriptine response in normoprolactinemic patients with polycystic ovary disease: A preliminary report. Obstet Gynecol 1984;64:213–219.
30.
Buvat J, Buvat-Herbaut M, Marcolin G, Racadot A, Fourlinnie JC, Beuscart R, Fossati P: A double blind controlled study of the hormonal and clinical effects of bromocriptine in the polycystic ovary syndrome. J Clin Endocrinol Metab 1986;63:119–124.
31.
Murdoch AP, McClean KG, Watson MJ, Dunlop W, Kendall Taylor P: Treatment of hirsutism in polycystic ovary syndrome with bromocriptine. Br J Obstet Gynaecol 1987;94:358–365.
32.
Polson DW, Mason HD, Franks S: Bromocriptine treatment of women with clomiphene-resistant polycystic ovary syndrome. Clin Endocrinol 1987;26:197–203.
33.
Hara M, Ichikawa K, Minemura K, Kobayashi H, Suzuki N, Sakurai A, Nishi Y, Hashizume K, Ohtsuka K: Acromegaly associated with Chiari-1 malformation and polycystic ovary syndrome. Int Med 1996;35:803–807.
34.
Laron Z, Aurbach-Klipper Y, Flastein B, Litwin A, Dickerman Z, Heding LG: Changes in endogenous insulin secretion during childhood as expressed by plasma and urinary C-peptide. Clin Endocrinol (Oxf) 1988;29:625–632.
35.
Venturoli S, Porcu E, Fabbri R, Magrini O, Paradisi R, Pallotti G, Gammi L, Flamigni C: Postmenarchal evolution of endocrine pattern and ovarian aspects in adolescents with menstrual irregularities. Fertil Steril 1987;48:78–85.
36.
Venturoli S, Porcu E, Fabbri R, Paradisi R, Ruggeri S, Bolelli G, Orsini LF, Gabbi D, Flamigni C: Menstrual irregularities in adolescents: Hormonal pattern and ovarian morphology. Horm Res 1986;24:269–279.
37.
Nobels F, Dewailly D: Puberty and polycystic ovarian syndrome: The insulin/insulin-like growth factor I hypothesis. Fertil Steril 1992;58:655–666.
38.
Bridges NA, Cooke A, Healy MJ, Hindmarsh PC, Brook CG: Ovaries in sexual precocity. Clin Endocrinol 1995;42:135–140.
© 2003 S. Karger AG, Basel
2003
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